Objective: The purpose of the present study was to examine whether intraindividual changes in physical activity were correlated with intraindividual changes in mental health (depression, anxiety, and ...burnout) across four measurement time-points over 6 years, both from between-person and within-person perspectives. Methods: Health care workers (N = 3717; mean age = 46.9; SD = 10.0) were the target population in this study, which is part of a larger longitudinal survey that included questionnaires on physical activity levels and mental health (depression, anxiety, and burnout) at four time points across 6 years (2004-2010). Physical activity was assessed with an adapted version of the widely used 1-item, 4-level Saltin Grimby Physical Activity Level Scale (SGPALS). Depression, anxiety, and burnout were assessed using the Hospital Anxiety and Depression (HAD) scale and the Shirom-Melamed Burnout Questionnaire (SMBQ). Bivariate latent growth curve models were used to analyze the associations of change between physical activity and mental health. Results: Baseline levels of physical activity were moderately associated with baseline levels of mental health (rs = −.27 to −.40, ps < .01). Changes in physical activity were moderately to strongly associated (rs = −.57 to −.79, ps <. 01) with change in mental health at the between-person (correlated change) level and significantly, but weakly (rs = −.08 to −.14, ps <.01), associated with change at the within-person (coupled change) level of analysis. Conclusions: Changes in physical activity were associated with, and traveled together with, changes in depression, anxiety, and burnout across time. Changes in physical activity, and not only current or previous levels of activity, may be important to consider in preventive work linked to mental health within this population.
The individual physical activity level is an independent risk factor for cardiovascular disease and death, as well as a possible target for improving health outcome. However, today's widely adopted ...risk score charts, typically do not include the level of physical activity. There is a need for a simple risk assessment tool, which includes a reliable assessment of the level of physical activity. The aim of this study was therefore, to analyse the association between the self-reported levels of physical activity, according to the Saltin-Grimby Physical Activity Level Scale (SGPALS) question, and cardiovascular risk factors, specifically focusing on the group of individuals with the lowest level of self-reported PA.
We used cross sectional data from the Intergene study, a random sample of inhabitants from the western part of Sweden, totalling 3588 (1685 men and 1903 women, mean age 52 and 51). Metabolic measurements, including serum-cholesterol, serum-triglycerides, fasting plasma-glucose, waist circumference, blood pressure and resting heart rate, as well as smoking and self-reported stress were related to the self-reported physical activity level, according to the modernized version of the SGPALS 4-level scale.
There was a strong negative association between the self-reported physical activity level, and smoking, weight, waist circumference, resting heart rate, as well as to the levels of fasting plasma-glucose, serum-triglycerides, low-density lipoproteins (LDL), and self-reported stress and a positive association with the levels of high-density lipoproteins (HDL). The individuals reporting the lowest level of PA (SGPALS, level 1) had the highest odds-ratios (OR) for having pre-defined levels of abnormal risk factors, such as being overweight (men OR 2.19, 95% CI: 1.51-3.19; women OR 2.57, 95 % CI: 1.78-3.73), having an increased waist circumference (men OR 3.76, 95 % CI: 2.61-5.43; women OR 2.91, 95% CI: 1.94-4.35) and for reporting stress (men OR 3.59, 95 % CI: 2.34-5.49; women OR 1.25, 95% CI: 0.79-1.98), compared to the most active individuals, but also showed increased OR for most other risk factors analyzed above.
The self-reported PA-level according to the modernized Saltin-Grimby Physical Activity Level Scale, SGPALS, is associated with the presence of many cardiovascular risk factors, with the most inactive individuals having the highest risk factor profile, including self-reported stress. We propose that the present SGPALS may be used as an additional, simple tool in a routine risk assessment in e.g. primary care, to identify inactive individuals, with a higher risk profile.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objective: To study the self-reported level of physical activity (PA) and quality of life (QOL) in patients receiving physical activity on prescription (PAP) for up to 24 months.
Design: ...Observational study conducted in a regular healthcare setting.
Setting: A primary care population in Sweden receiving physical activity on prescription as part of regular care was studied alongside a reference group.
Subjects: The group comprised 146 patients receiving PAP at two different primary care locations (n = 96 and 50, respectively). The reference group comprised 58 patients recruited from two different primary care centres in the same region.
Main outcome measurements: We used two self-report questionnaires - the four-level Saltin-Grimby Physical Activity Level Scale (SGPALS) to assess physical activity, and SF-36 to assess QOL.
Results: A significant increase in the PA level was found at six and 12 months following PAP, with an ongoing non-significant trend at 24 months (p = .09). A clear improvement in QOL was seen during the period. At 24 months, significant and clinically relevant improvements in QOL persisted in four out of eight sub-scale scores (Physical Role Limitation, Bodily Pain, General Health,Vitality) and in one out of two summary scores (Physical Component Summary).
Conclusion: Patients receiving PAP showed an increased level of self-reported PA at six and 12 months and improved QOL for up to 24 months in several domains. The Swedish PAP method seems to be a feasible method for bringing about changes in physical activity in different patient populations in regular primary healthcare.
While increased physical activity (PA) is shown to improve health, the implementation of methods designed to increase activity is still being developed.
Key points
The present study confirms that the Swedish physical activity on prescription (PAP) method increases the self-reported level of PA in the primary care setting at six and 12 months.
Furthermore, this study shows that PAP recipients report a clinically relevant long-term improvement in quality of life, persisting for two years post-prescription, thus extending earlier findings.
These findings have clinical implications for the implementation of PAP in healthcare.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Exhaustion disorder (ED) is a stress-related disorder characterized by physical and mental symptoms of exhaustion. Recent data suggest that pathophysiological processes in the central nervous system ...are involved in the biological mechanisms underlying ED. The aims of this study were to investigate if plasma levels of neuro-related proteins differ between patients with ED and healthy controls, and, if so, to investigate if these differences persist over time. Using the Olink Neuro Exploratory panel, we quantified the plasma levels of 92 neuro-related proteins in 163 ED patients at the time of diagnosis (baseline), 149 patients at long-term follow-up (7–12 years later, median follow-up time 9 years and 5 months), and 100 healthy controls. We found that the plasma levels of 40 proteins were significantly higher in the ED group at baseline compared with the control group. Out of these, the plasma levels of 36 proteins were significantly lower in the ED group at follow-up compared with the same group at baseline and the plasma levels of four proteins did not significantly differ between the groups. At follow-up, the plasma levels of two proteins were significantly lower in the ED group compared with the control group. These data support the hypothesis that pathophysiological processes in the central nervous system are involved in the biological mechanisms underlying ED.
•Biological mechanisms in exhaustion disorder (ED) were investigated.•92 neuro-related proteins were quantified in patients with ED and controls.•Increased plasma levels of neuro-related proteins in patients with ED.•Most proteins had normalized at long-term follow-up.
Burnout has several different definitions, and attempts have been made to discriminate between burnout as a psychological construct and burnout as a clinical entity. A large body of research has ...focused on elucidating the biological link between stress exposure and burnout and/or finding a clinically usable biomarker for burnout. The objective of this narrative review is to summarize the main endocrine and immune findings in relation to burnout. The literature has primarily focused on dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis. However, albeit the large body of studies, it cannot be concluded that clear effects are seen on HPA axis function in people with burnout. The HPA axis and anabolic acute reactivity to stress might be affected in clinical burnout. Plausible, effects of chronic stress might rather be seen when measuring responses to acute stress rather than resting state hormonal levels. Studies on other hormones, including thyroid hormones, prolactin and growth hormone in burnout subjects are inconclusive. It is important to note that this field is faced with many methodological challenges, one being the diurnal and pulsatile nature of many of the hormones of interest, including cortisol, which is not always considered. Another challenge is the heterogeneity regarding definitions and measurements of stress and burnout. Existing studies on burnout and immune function are heterogeneous regarding the results and no firm conclusion can be made if clinically relevant immune changes are present in burnout subjects. An overall conclusion is that existing research cannot confirm any homogenous reliable endocrinological or immunological changes related to burnout.
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.
It is known that long-term psychosocial stress may cause or contribute to different diseases and symptoms and accelerate aging. One of the consequences of prolonged psychosocial stress may be a ...negative effect on the levels of dehydroepiandrosterone (DHEA) and its sulphated metabolite dehydroepiandrosterone sulphate (DHEA-S). The aim of this study is to investigate whether levels of DHEA and DHEA-S differ in individuals who report perceived stress at work compared to individuals who report no perceived stress at work.
Morning fasting DHEA-S and DHEA levels were measured in serum in a non-stressed group (n = 40) and a stressed group (n = 41). DHEA and DHEA-S levels were compared between the groups using ANCOVA, controlling for age.
The mean DHEA-S levels were 23% lower in the subjects who reported stress at work compared to the non-stressed group. Statistical analysis (ANCOVA) showed a significant difference in DHEA-S levels between the groups (p = 0.010). There was no difference in DHEA level between the groups.
This study indicates that stressed individual have markedly lower levels of DHEA-S. Given the important and beneficial functions of DHEA and DHEA-S, lower levels of DHEA-S may constitute one link between psychosocial stress, ill health and accelerated ageing.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
PURPOSEThis cross-sectional observational study examined the degree to which cardiorespiratory fitness (CRF) and self-perceived stress are associated with cardiometabolic risk factors and the overall ...risk score for cardiovascular diseases. The second aim was to determine whether participants’ CRF levels moderate the relationships between stress and cardiometabolic risk.
METHODSA gender-matched stratified sample (N = 197, 51% men, Mage = 39.2 yr) was used to ensure that participants with varying stress levels were equally represented. CRF was assessed with the Åstrand bicycle test, and perceived stress was assessed with a single-item question. Systolic blood pressure (SBP) and diastolic blood pressure (DBP), body mass index (BMI), total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), glycated hemoglobin, and total cardiometabolic risk score (sum of the z-standardized residuals of the previously mentioned indicators) were assessed as outcomes.
RESULTSHigher LDL-C, TG, and total metabolic risk were found in participants with high stress scores (P < 0.05). In addition, lower SBP, DBP, BMI, LDL-C, TG, and total metabolic risk were observed in participants with high CRF (P < 0.05). Two-way ANCOVA provided significant interaction effects for five of the nine outcome variables (P < 0.05, 3.6%–4.8% of explained variance). Participants with high stress who also had high CRF levels had lower SBP, DBP, LDL-C, TG, and total cardiometabolic risk than participants with high stress but low or moderate CRF levels. No significant main or interaction effects occurred for BMI, total cholesterol, high-density lipoprotein cholesterol, and glycated hemoglobin.
CONCLUSIONBetter CRF is associated with more favorable levels of several cardiometabolic risk factors, specifically in participants experiencing high stress. Higher CRF may provide some protection against the health hazards of high chronic stress by attenuating the stress-related increase in cardiovascular risk factors.
•Decreased morning output of cortisol in women reporting non-work stress.•Flatter diurnal cortisol slope in women reporting non-work stress.•Non-work stress could be important for diurnal cortisol ...secretion.•Women are potentially more vulnerable to non-work stress.
This study investigated the association between diurnal salivary cortisol profile and perceived stress at work and at home.
Healthy participants (N=180, 52% women) collected saliva cortisol samples immediately after waking up, 15min later, 30min later, and at 9:00, 12:00, 15:00, 18:00 and 21:00. The area under the cortisol awakening curve with respect to ground (AUCgCAR) and increase (AUCiCAR), and diurnal slope between 9:00 and 21:00 were analyzed. Perceived stress at work and at home was measured with the Stress-Energy Questionnaire.
Participants reporting stress at home had significantly lower AUCgCAR and a flatter diurnal slope. When performing separate analyses for men and women, this association was only significant among women. Perceived stress at work was not associated with any cortisol measure.
This study highlights the importance of stress outside the workplace. The sex differences may indicate an increased vulnerability to non-work stress in women.
This study aimed to investigate the impact of the first wave of the COVID-19 pandemic on perceived working environment, including the possibility to recover, among psychiatric healthcare workers ...(PHCWs) in comparison with pre-pandemic measures.
A link to an anonymous, web-based COVID-19 related survey was sent
email to all PHCWs at a university hospital in Sweden (
= 1,618) in September 2020. The response rate was 38% (566 of 1,507 eligible participants). Working environment survey responses collected in 2019 were used as pre-pandemic comparators. Statistical analyses were performed to assess overall impact over time on work demands, support, motivation, and recovery, stratified by professional role, and considering variables such as access to personal protective equipment.
The percentage of individuals responding negatively to statements about working environment increased significantly for most items after the first wave. Similarly, the increase of five of the investigated factors indicated a more negative perception of recovery during the pandemic. Registered nurses reported a greater negative impact of the pandemic on perceived working conditions and ability to recover than other professional groups. PHCWs working with patients with COVID-19 (35%) who reported being worried about becoming infected (12%) or infecting others (17%), or lacking adequate personal protective equipment (22%) were more negatively impacted regarding work environment-related items than those who did not.
PHCWs' working environment and possibility for recovery were impacted by the first wave of the COVID-19 pandemic, nurses being most affected. Although psychiatric services do not directly care for patients with severe COVID-19 infection, the results from this study suggests that mental health services should also prepare for future pandemics.
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