Work functioning in persons with depressive and anxiety disorders: the role of specific psychopathological characteristics

Socioeconomic status, psychotherapy duration, and return to work from disability due to common mental disorders

Objective Low socioeconomic status (SES) is a risk factor for work disability due to common mental disorders (CMDs), one possible reason being inequal use of services. Psychotherapy is an evidence-based treatment for CMDs. This study examines socioeconomic and sociodemographic differences in psychotherapy attendance and an association of psychotherapy duration with return to work (RTW).Methods The study subjects (N = 12,263) were all Finnish citizens granted a disability pension (DP) due to CMDs in 2010-2012. Numbers of psychotherapy sessions (maximum 200) were collected from the nine-year interval around the DP grant. Socioeconomic and sociodemographic differences in psychotherapy duration (dependent variable) among DP recipients were studied using multinomial logistic regression models, likewise, the association between psychotherapy duration and RTW (dependent variable) among temporary DP recipients was examined.Results Higher SES, female gender, and younger age were positively associated with attending longer psychotherapies and surpassing the early treatment termination level (>10 sessions). Attending 11-60 psychotherapy sessions was positively associated with full RTW and partial RTW, whereas longer psychotherapies were not. Early termination was positively associated with partial RTW only.Conclusion This study demonstrates varying tendencies among CMD patients from different backgrounds to attend long rehabilitative psychotherapies, which may create inequalities in RTW.

Prevalence and factors associated with depression and anxiety among COVID-19 survivors in Dhaka city

Background

Coronavirus disease 2019 (COVID-19) is a global public health concern. Evidence shows that depression and anxiety are common among patients with COVID-19 after recovery. About one-third of the total COVID-19 cases in Bangladesh have been reported in Dhaka city. Therefore, the study aimed to evaluate the prevalence of depression and anxiety among COVID-19 survivors in Dhaka city as well as to identify the factors associated with these mental health conditions.

Methods

A cross-sectional study was carried out among a total of 384 COVID-19 survivors aged 18 years or older. Data collection was done through face-to-face and telephone interviews using a semi-structured questionnaire. Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) scales were used to assess depression and anxiety, respectively. Binary logistic regression analysis was performed to identify the predictors of depression and anxiety among patients recovered from COVID-19.

Results

The overall prevalence of depression and anxiety was 26.0% and 23.2%, respectively among COVID-19 survivors. The respondents who were ≥60 years were 2.62 and 3.02 times more likely to report depressive and anxiety symptoms, respectively than those aged 18 to 39 years. Hospitalised patients recovered from COVID-19 had a 2.18 times higher chance of developing anxiety than their non-hospitalised counterparts. COVID-19 recovered patients with comorbidities were at 3.35 and 2.97 times higher risk of depression and anxiety, respectively compared to those without comorbidities. Similarly, the respondents who had already passed a period of 15 days to 3 months after recovery showed 3.06 and 1.85 times higher odds of depression and anxiety, respectively than those who had already passed a period of above 3 to 6 months after recovery.

Conclusion

The study reported a high prevalence of depression and anxiety among COVID-19 survivors living in Dhaka city. The findings suggest the need for appropriate interventions to reduce mental health complications in COVID-19 survivors.

Validity of the Capacity to Work Index: Development of an Instrument to Measure Work Capacity in Relation to Depression and Anxiety in the General Working Population

PURPOSE

To develop an index to assess capacity to work in relation to common mental disorders (CMDs) in the general working population and field test its psychometric properties.

METHODS

Content analysis of three qualitative studies on people (n = 49) with their own experiences of working with CMD guided the items selected for the index. Face and content validity and test-retest reliability were performed. The index was field tested in two versions with 26 and 17 items, respectively, among health care professionals regarding internal reliability, component structure and concurrent validity.

RESULTS

The final version of the Capacity to Work Index (C2WI; 17 items) was normally distributed in the field test with high internal reliability (Cronbach's alpha, 0.84). Missing responses were randomly distributed and nonspecific. Principal component analysis showed one clear component with negatively framed items. Concurrent validity showed high correlation with the WHO-5 Well-Being Scale (Pearson's r, 0.68), but lower correlation for the general health question (r, - 0.44), one item of the Work Ability Index (r, - 0.33), and the Stress of Conscience constructs (r, 0.44).

CONCLUSION

The C2WI showed promising psychometric qualities. Low and negative correlation with the item from Work Ability Index suggests that the C2WI measures additional dimensions, but further testing in larger and more diverse samples is required.

Specifying the Efficacy of Digital Therapeutic Tools for Depression and Anxiety: Retrospective, 2-Cohort, Real-World Analysis

BACKGROUND

Depression and anxiety are the main sources of work and social disabilities as well as health-related problems around the world. Digital therapeutic solutions using cognitive behavioral therapy have demonstrated efficacy in depression and anxiety. A common goal of digital health apps is to increase user digital engagement to improve outcomes. However, there is a limited understanding of the association between digital platform components and clinical outcomes.

OBJECTIVE

The aim of the study is to investigate the contribution of specific digital engagement tools to mental health conditions. We hypothesized that participation in coaching sessions and breathing exercises would be associated with a reduction in depression and anxiety.

METHODS

Depression and general anxiety symptoms were evaluated in real-world data cohorts using the digital health platform for digital intervention and monitoring change. This retrospective real-world analysis of users on a mobile platform-based treatment followed two cohorts of people: (1) users who started with moderate levels of depression and completed at least 2 depression assessments (n=519) and (2) users who started with moderate levels of anxiety and completed at least 2 anxiety assessments (n=474). Levels of depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7) were tracked throughout the first 16 weeks. A piecewise mixed-effects model was applied to model the trajectories of the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7 mean scores in 2 segments (1-6 weeks and 7-16 weeks). Finally, simple slope analysis was used for the interpretation of the interactions probing the moderators: coaching sessions and breathing exercises in both depression and anxiety cohorts.

RESULTS

Analysis revealed a significant decrease in depression symptoms (β=-.37, 95% CI -0.46 to 0.28; P≤.001) during the period of weeks 1-6 of app use, which was maintained during the period of 7-16 weeks. Coach interaction significantly moderated the reduction in depression symptoms during the period of weeks 1-6 (β=-.03, 95% CI -0.05 to -0.001; P=.02). A significant decrease in anxiety symptoms (β=-.41, 95% CI -0.50 to -0.33; P≤.001) was revealed during the period of 1-6 weeks, which was maintained during the period of 7-16 weeks. Breathing exercises significantly moderated the reduction in anxiety symptoms during the period of 1-6 weeks (β=-.07, 95% CI -0.14 to -0.01; P=.04).

CONCLUSIONS

This study demonstrated general improvement followed by a period of stability of depression and anxiety symptoms associated with cognitive behavioral therapy-based digital intervention. Interestingly, engagement with a coaching session but not a breathing exercise was associated with a reduction in depression symptoms. Moreover, breathing exercise but not engagement with a coaching session was associated with a reduction of anxiety symptoms. These findings emphasize the importance of using a personalized approach to behavioral health during digital health interventions.

Prevalence and factors associated with anxiety and depression among Chinese prison officers during the prolonged COVID-19 pandemic

Objective

This study examined the prevalence of anxiety and depression-along with the potential risk and protective factors-among Chinese prison officers during the prolonged COVID-19 pandemic.

Method

A cross-sectional survey of 1,268 officers from five prisons in western and southern China was administered between June and July 2022. The questionnaires comprised two sections. In the first section, the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) were used to evaluate the prevalence of anxiety and depression, respectively, among prison officers. In the second section, the potential influencing factors were examined. Categorical data were compared using χ2 tests and t-tests; binary logistic regression analysis was performed to identify factors associated with anxiety and depression.

Results

The prevalence rates of anxiety and depression among the prison officers were 72.6% and 69.8%, respectively. Risk factors for anxiety were older age, being unmarried, work-family conflicts, job demands, and COVID-19 burnout; protective factors were exercise, positive family relationships, and group cohesion. Work-family conflicts, job demands, intolerance of uncertainty regarding COVID-19, and COVID-19 burnout were risk factors for depression, whereas annual income >150,000 RMB, exercise, positive family relationships, group cohesion, and job autonomy were protective factors against depression.

Conclusion

The prevalence of anxiety and depression among Chinese prison officers was relatively high during the prolonged COVID-19 pandemic, and more targeted measures should be implemented to improve their mental health. This study offers a reference for improving prison officers' mental health in response to similar public health emergencies in the future.

Moderators of the cost-effectiveness of transdiagnostic CBT for anxiety disorders over an 8-month time horizon using a net-benefit regression framework

BACKGROUND

Access to evidence-based psychological treatment is a concern in many parts of the globe due to government-level financial constraints and patient-level barriers. Transdiagnostic cognitive behavioural therapy (tCBT) is an effective treatment approach that uses a single protocol for anxiety disorders which could enhance the dissemination of evidence-based psychotherapy. In a context of limited resources, the study of treatment moderators can allow to identify subgroups for which the cost-effectiveness of an intervention differs, information that could impact decision-making. So far, there has been no economic evaluation of tCBT for different subpopulations. The objectives of this study, using the net-benefit regression framework, were to explore clinical and sociodemographic factors as potential moderators of the cost-effectiveness of tCBT compared to treatment-as-usual (TAU).

METHODS

This is a secondary data analysis of a pragmatic randomized controlled trial opposing tCBT added to TAU (n = 117) to TAU only (n = 114). Data on costs from the health system and the limited societal perspectives, as well as anxiety-free days, an effectiveness measure based on the Beck Anxiety Inventory, were collected over an 8-month time horizon and used to derive individual net-benefits. The net-benefit regression framework was used to assess moderators of the cost-effectiveness of tCBT + TAU as opposed to TAU alone. Variables of sociodemographic and clinical nature were assessed.

RESULTS

Results showed that the number of comorbid anxiety disorders significantly moderated the cost-effectiveness of tCBT + TAU compared to TAU from the limited societal perspective.

CONCLUSIONS

The number of comorbid anxiety disorders was identified as a moderator affecting the cost-effectiveness of tCBT + TAU compared to TAU from the limited societal perspective. More research is needed to strengthen the case of tCBT from an economic standpoint for large-scale dissemination.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT02811458, 23/06/2016.

Psychotic symptoms and neurocognition among patients with major depressive disorder: A chained mediation model of depressive symptoms and socio-occupational functioning

BACKGROUND

Depressive symptom and psychotic symptom have been identified as risk factors for impaired socio-occupational functioning in patients with major depressive disorder (MDD), while neurocognitive functioning is considered to be a potential protective factor against socio-occupational functioning. Nevertheless, little is known about the complex relationship among these factors in patients with MDD. The purpose of this research was to explore whether the relationship between depressive symptom severity and social-occupational functioning is mediated by neurocognitive functioning and psychotic symptom severity in MDD patients.

METHODS

A total of 659 eligible MDD patients included male and female, and their depressive symptoms and psychotic symptoms at baseline were assessed by the 17-item Hamilton Depression Scale (HAMD-17) and The Brief Psychiatric Rating Scale (BPRS) respectively. Cognitive domains were assessed by the MATRICS Consensus Cognitive Battery (MCCB), and subjective and objective functioning were measured by the Global Assessment of Functioning (GAF).

LIMITATION

The analysis is cross-sectional, which limits causal inference.

RESULT

(1) The correlation between depressive symptoms and thought disturbance was positive (r = 0.125, p = 0.001), whereas the correlations with visual learning and memory (r = -0.146, p < 0.001) and socio-occupational functioning (r = -0.175, p < 0.001) were negative. (2) Depressive symptoms mainly affect the socio-occupational functioning of MDD patients via three indirect effects: the single mediating effect of psychotic symptoms and neurocognitive functioning, and the chain mediating effect of psychotic symptoms and neurocognitive functioning.

CONCLUSIONS

The results suggest that the relationship between depressive symptom severity and socio-occupational functioning in MDD patients is partially mediated by psychotic symptom severity and neurocognitive functioning.

Profiles of risk factors for depressive and anxiety symptoms during the COVID-19 pandemic: A latent class analysis

The COVID-19 pandemic has caused a high burden in the general population. The exposure to an accumulation of risk factors, as opposed to a single risk, may have been associated with higher levels of depressive and anxiety symptoms during the pandemic. This study aimed to (1) identify subgroups of individuals with distinct constellations of risk factors during the COVID-19 pandemic and (2) investigate differences in levels of depressive and anxiety symptoms. German participants (N = 2245) were recruited between June-September 2020 through an online survey (ADJUST study). Latent class analysis (LCA) and multiple group analyses (Wald-tests) were conducted to identify profiles of risk factors and examine differences in symptoms of depression (PHQ-9) and anxiety (GAD-2). The LCA included 14 robust risk factors of different domains, for example, sociodemographic (e.g., age), health-related (e.g., trauma), and pandemic-related (e.g., reduced income) factors. The LCA identified three risk profiles: High sociodemographic risk (11.7%), high social and moderate health-related risk (18.0%), and low general risk (70.3%). Individuals with high sociodemographic risk reported significantly higher symptom levels of depression and anxiety than the remaining groups. A better understanding of risk factor profiles could help to develop targeted prevention and intervention programs during pandemics.

The Role of Mental Health on Workplace Productivity: A Critical Review of the Literature

BACKGROUND

Mental health disorders in the workplace have increasingly been recognised as a problem in most countries given their high economic burden. However, few reviews have examined the relationship between mental health and worker productivity.

OBJECTIVE

To review the relationship between mental health and lost productivity and undertake a critical review of the published literature.

METHODS

A critical review was undertaken to identify relevant studies published in MEDLINE and EconLit from 1 January 2008 to 31 May 2020, and to examine the type of data and methods employed, study findings and limitations, and existing gaps in the literature. Studies were critically appraised, namely whether they recognised and/or addressed endogeneity and unobserved heterogeneity, and a narrative synthesis of the existing evidence was undertaken.

RESULTS

Thirty-eight (38) relevant studies were found. There was clear evidence that poor mental health (mostly measured as depression and/or anxiety) was associated with lost productivity (i.e., absenteeism and presenteeism). However, only the most common mental disorders were typically examined. Studies employed questionnaires/surveys and administrative data and regression analysis. Few studies used longitudinal data, controlled for unobserved heterogeneity or addressed endogeneity; therefore, few studies were considered high quality.

CONCLUSION

Despite consistent findings, more high-quality, longitudinal and causal inference studies are needed to provide clear policy recommendations. Moreover, future research should seek to understand how working conditions and work arrangements as well as workplace policies impact presenteeism.

Digital phenotyping of generalized anxiety disorder: using artificial intelligence to accurately predict symptom severity using wearable sensors in daily life

BACKGROUND

Generalized anxiety disorder (GAD) is a highly prevalent condition. Monitoring GAD symptoms requires substantial time, effort, and cost. The development of digital phenotypes of GAD may enable new scalable, timely, and inexpensive assessments of GAD symptoms.

METHOD

The current study used passive movement data collected within a large national cohort (N = 264) to assess GAD symptom severity.

RESULTS

Using one week of movement data, machine learning models accurately predicted GAD symptoms across a continuum (r = 0.511) and accurately detected those individuals with elevated GAD symptoms (AUC = 0.892, 70.0% Sensitivity, 95.5% Specificity, Brier Score = 0.092). Those with a risk score at the 90^th percentile or above had 21 times the odds of having elevated GAD symptoms compared to those with lower risk scores. The risk score was most strongly associated with irritability, worry controllability, and restlessness (individual rs > 0.5). The risk scores for GAD were also discriminant of major depressive disorder symptom severity (r = 0.190).

LIMITATIONS

The current study examined the detection of GAD symptom severity rather than the prediction of GAD symptom severity across time. Furthermore, the instant sample of data did not include nighttime actigraphy, as participants were not asked to wear the actigraphs at night.

CONCLUSIONS

These results suggest that artificial intelligence can effectively utilize wearable movement data collected in daily life to accurately infer risk of GAD symptoms.

Migraine in the workplace

Migraine is prevalent, disabling, and peaks during people's peak productive years. The impact of migraine on people's professional lives, work productivity, and interpersonal relationships at work eventually affects everyone, has a significant detrimental effect on people with migraine, and a huge cost in terms of lost productivity. People with migraine want to work, so they do their best to work despite the varied migraine related and associated symptoms. Most of migraine-related productivity loss (89%) is due to presenteeism. People are less than half effective during a migraine attack due to the pain, migraine symptoms, attack unpredictability, migraine comorbidities, emotional impact, under-diagnosis and under-management, and the stigma. Migraine-related productivity loss may negatively affect people's career choice, job status and/or security, financial status, work relationships, mood, and confidence. Migraine is estimated to represent 16% of total US workforce presenteeism. Thankfully, there are ways to help support people with migraine in the workplace and increase their productivity such as: workplace migraine education programs, workplace migraine education and management programs, migraine-friendly work environment, migraine treatment optimization and advocacy. The example of the successful workplace migraine education and management program developed and run in collaboration between Fujitsu, the Japanase Headache Society, and the International Headache Society Global Patient Advocacy Coalition is discussed.

•

Migraine-related productivity loss is costly to people with migraine, to employers, and to everyone in one way or another.

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Workplace migraine education and/or management programs and migraine-friendly environment help people with migraine at work.

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Neurologists can help support their patients in the workplace and get involved in advocacy in many ways.

Anger, personality traits and psychopathological symptoms in subjects exposed to negative interpersonal actions in workplaces: an observational study in a large sample attending a Center for Occupational Stress

OBJECTIVE

The association between adverse working conditions and mental disorders is well established. In addition to psychopathological symptoms, this study aimed at investigating anger and personality traits in a clinical sample of subjects referring negative interpersonal experiences in workplaces.

METHODS

1676 workers attending a Centre for Occupational Stress in Milan (from 2014 to 2016) were administered an assessment protocol including SCL-90 for general psychopathology, STAXI for anger intensity and expression, and MMPI-2 for personality traits. A qualitative checklist was used to collect negative experiences in workplaces.

RESULTS

Patients reported they were exposed to "threats to the task or the professional career" more than to "attacks to the person". Over 80% scored above the cutoff in all the subscales of the SCL-90, with highest scores in Depression, Obsessive-Compulsive Disorder, Anxiety, Somatization and Paranoia. 60% scored above the 90th percentile in the AX/in subscale, showing intense anger feelings that they mostly suppress. Abnormal elevations at the MMPI scales of Hypochondria, Depression, Hysteria, and Paranoia were found in over 50% of the sample. Women reported higher psychological difficulties and internalized anger than men. Anger towards objects and people, instead, was more common in males. No differences were observed by work sector or employment status.

CONCLUSIONS

In addition to severe psychological difficulties, individuals reporting negative interpersonal experiences in workplaces have high levels of internalized anger and a distinctive profile of personality traits. While a deeper investigation is needed, anger expression should be considered in future treatment programs.

Individual placement and support and employment in personality disorders: a registry based cohort study

BACKGROUND

To explore the relative impact of Individual Placement and Support (IPS) in patients with personality disorders (PDs) as compared to patients with other mental disorders.

METHODS

Data from the Dutch Employee Insurance Agency of participants enrolled in a national IPS trajectory between 2008 and 2018 were linked to corresponding data on employment outcomes, diagnostic and sociodemographic information from Statistics Netherlands. This resulted in a sample of 335 participants with PDs who could be compared with 1073 participants with other mental disorders.

RESULTS

Participants with PD just as often found competitive employment as participants with other mental disorders (37.6% vs. 38.0%, OR_adjusted = 0.97, 95% confidence interval (CI) 0.74 to 1.27). The median time to gaining employment for those gaining employment (37.9%) was 195.5 days (mean number of days 252.5) in the PD group and 178.5 days (mean number of days 234.6) in the other mental disorders group (HR_adjusted = 0.95, 95% CI 0.77 to 1.18). Also, total number of hours paid for competitive employment did not differ significantly between groups (median hours 686.5 vs 781.5, IRR_adjusted = 0.85 95% CI 0.69 to 1.05).

CONCLUSIONS

Based on this study, which includes the largest sample of patients with PDs in any published IPS study, IPS seems to result in an equal percentage of patients with PDs and other mental disorders, gaining and maintaining employment. Although future studies should determine whether PD-specific adaptations to IPS are useful, our findings indicate that IPS could be an effective way to increase employment outcomes in PDs. This is important because the enormous societal costs of PDs are largely driven by loss of economic productivity, and because clinical recovery in PDs is suggested to be enhanced when patients are employed.

The Thought of Death in a Pandemic Era: Can Anxiety Determine the Nexus between the Accessibility, Availability and Use of Personal Protective Equipment (PPE) for COVID-19 and Work Behaviour among Aviation Workers?

Since the emergence of COVID-19, the aviation sector has been one of the numerous industries which have been affected the most. In this present paper, the thought of death among aviation workers as an indicator of anxiety at a time when the availability, access to, and use of Personal Protective Equipment (PPE) remains paramount to the survival of work in the line of duties and its influence on different work behaviors was assessed. The theoretical foundation of the study was built on the process efficiency theory, attentional interference theory, and the terror management theory (TMT), which focuses on both the psychological and emotional responses exhibited by people due to fear or worry about a specific situation. The study adopted an exploratory study design that incorporates a cross-sectional and self-reported survey among 646 frontline workers across 12 international airlines and the Ghana Airport Company Limited (GACL), Accra, Ghana using simple random sampling and convenient sampling techniques. After all the preliminary tests were performed, the path analysis estimated by Structural Equation Modelling (SEM) indicated that anxiety has a significant influence on workers’ stress-adaptive performance and task performance, but recorded no significant causal link with interpersonal performance. The findings indicated that all three proxies of employee work behaviours, which focus on both adaptive and task performance, were significantly related to workers’ access, availability, and use of PPE (APPE). The association between anxiety and APPE was also found to be significant. Bootstrapping mediation analysis shows that anxiety partially mediates the influence APPE has on both stress-adaptive performance and task performance, but did not show any mediating effect on the association between APPE and interpersonal performance. Among the three dimensions of death anxiety, both the fear of death (FDE) and death intrusion (DINT) indicated a significant partial mediating effect on the influence APPE has on all three multidimensional constructs of work behaviours. The findings literally prove that worrying about the fatality risk associated with COVID-19 is highly predictive.

Let the team fix it?-Performance and mood of depressed workers and coworkers in different work contexts

Depression in the workplace is a significant factor for reduced personal well-being and productivity. Consequently, this has negative effects on the economic success of the companies in which depressed people are employed. In addition, the economy has to deal with the significant burden of this illness on the health system. In this paper, we investigated how different working contexts—working in a group or individually—influenced depressed individuals towards higher or lower well-being and productivity. We examined this using a laboratory experiment. In this setting, we were also able to analyze how, in turn, a depressive individual impacted the productivity and affective situation of their workgroup, reflecting the company perspective. The experimental design mimicked the very basic processes of a workplace in a stylized way. We used two distinct samples: subclinically and clinically depressed, both working in a group with healthy controls. As expected, we found generally lower performance in the clinically depressed sample, but in the subclinically depressed sample, we only found this in the individual work context. In contrast to our expectations, the performance of subclinically depressed individuals working in groups with healthy controls was even higher than that of healthy controls in homogenously healthy groups. The performance of the entire group with a depressed member was lower for the sample with clinically manifested depression, while the performance of groups with a subclinically depressed participant was significantly higher than the performance of homogeneously non-depressed control groups. We discuss our results with a focus on the design of workplaces to both re-integrate clinically depressed employees and prevent subclinically depressed employees from developing major depression.

Effect of internet-based attention bias modification on the anxiety of Japanese workers: A randomized controlled trial

Objectives

This study comprised a randomized controlled trial to examine the effect of internet‐based attention bias modification (iABM) on reducing workers' anxiety.

Methods

In total, 300 eligible participants were randomized according to sex and age; 180 were assigned to the intervention group and 120 to the control group. The word stimuli used in the iABM included eight positive words and eight neutral words. Participants were instructed to indicate the positive word's position as quickly and accurately as possible by tapping one of the two directions on display. The intervention included five sessions per participant over 1 month, resulting in a total of 600 trials. The main outcome measure was the total state anxiety score of the State‐Trait Anxiety Inventory (STAI).

Results

There was no significant difference in the net change in STAI scores between the intervention and control groups. The mean reaction time of the fifth session was significantly shorter than the mean reaction time of the first session. Furthermore, although there was no effect on the index of effect size Δ, the paired t‐test showed a significant decrease in the anxiety score.

Conclusions

The iABM intervention in this study did not enhance the amelioration of workers' anxiety when compared with the control condition.

Mediating Effect of Burnout on the Association between Work-Related Quality of Life and Mental Health Symptoms

The purpose of this study was: (1) to assess levels of burnout, work-related quality of life (WRQoL) and mental health symptoms among a sample of active workers living in Portugal; (2) to analyze differences in burnout, WRQoL and mental health symptoms by gender and shift work; (3) to analyze association levels among all variables under study; (4) to determine the predictive effect of burnout and WRQoL on mental health symptoms; and (5) to assess the mediating effect of burnout on the association between WRQoL and mental health symptoms. Eight-hundred and forty-one Portuguese active workers between 18 and 67 years of age participated in this study (Mean = 37.23; SD = 11.99). Results showed that women participants scored higher in burnout and mental health symptoms, and lower in overall WRQoL, than men; additionally, participants who worked in shifts presented higher mental health symptoms. Significant correlations were found for all variables and regression analysis demonstrated that 56% of the overall variance of mental health symptoms was explained by older age, shift work, lower WRQoL, and burnout (exhaustion and cognitive impairment). Finally, the mediation effect of burnout on the association between WRQoL and mental health symptoms was statistically significant. These findings are useful for health professionals and health managers who work in the field of occupational health in identifying variables affecting burnout, WRQoL and mental health symptoms.

Association between Job-Related Factors and Work-Related Anxiety, and Moderating Effect of Decision-Making Authority in Korean Wageworkers: A Cross-Sectional Study

Among the factors causing workers' anxiety, job-related factors are important since they can be managed. Therefore, this study aimed to analyze the association between work-related anxiety and job-related factors among Korean wageworkers using data from the Fifth Korean Working Conditions Survey. Participants were 13,600 Korean wageworkers aged <65 years. We analyzed the association between job-related factors and work-related anxiety, and the moderating effect of decision-making authority. "Meeting precise quality standards," "Solving unforeseen problems on your own," "Complex tasks," "Learning new things," "Working at very high speed," and "Working to tight deadlines" were positively associated with work-related anxiety. "Monotonous tasks" was negatively associated with work-related anxiety. The odds ratio (OR) of "Complex tasks" was higher in the group that had insufficient decision-making authority (OR 3.92, 95% confidential interval (CI) 2.40-6.42) compared to that with sufficient decision-making authority (OR 2.74, 95% CI 1.61-4.67). The risk of work-related anxiety was higher when the workers experienced time pressure, carried out tasks with high mental and physical demands, and dealt with unpredictable situations. This association was more pronounced when decision-making authority was insufficient.

Mental Health Outcomes Among Civil Servants Aiding in Coronavirus Disease 2019 Control

Objective: To assess the psychiatric status of Chinese civil servants aiding in coronavirus disease 2019 (COVID-19) control.

Background: During the COVID-19 pandemic, Chinese civil servants have faced high workloads that may contribute to mental disorders. We assessed the prevalence of both depression and anxiety symptoms among civil servants in Jiangsu and surrounding provinces using the Chinese versions of the 9-item Patient Health Questionnaire (PHQ-9) and the 7-item Generalized Anxiety Disorder (GAD-7) scale.

Methods: The PHQ-9 and GAD-7 were used to assess the severity of symptoms of depression and anxiety, respectively. Multivariable logistic regression analysis was performed to identify factors associated with mental health outcomes.

Results: In total, 867 Chinese civil servants aiding in COVID-19 control were included in our study. Overall, 37.25 and 38.06% of all respondents reported having symptoms of depression and anxiety, respectively. Respondents who were younger and more educated and those who had fewer years of work experience had higher scores for both depression and anxiety. Multivariable logistic regression analysis showed that being a woman, being younger, having more education and having fewer years of work experience were associated with a higher risk of symptoms of depression and anxiety. However, whether they had experience combating infectious diseases or worked in frontline, there was no significant difference between respondents with and without experience, as well as between frontline and non-frontline workers, in both symptoms of depression and anxiety.

Conclusions: The civil servants aiding in COVID-19 control reported suffering from varying degrees of mental disorders. Therefore, more attention should be devoted to the psychological distress of these civil servants.

Prevalence of Depression and Anxiety in Adolescents With Hearing Loss

OBJECTIVE

To develop and implement a universal screening protocol for depression and anxiety in adolescents serviced in an otology and audiology practice and to estimate the prevalence of depression and anxiety in adolescents with hearing loss, while also comparing rates by degree of hearing loss and type of hearing device used.

STUDY DESIGN

Cross-sectional.

SETTING

University tertiary medical center.

PATIENTS

One hundred four adolescents 12- to 18-years-old who attended an otology clinic in a large metropolitan hospital in the southeastern United States.

MAIN OUTCOME MEASURE

(s): Depression (PHQ-8), anxiety (GAD-7), degree of hearing loss, type of hearing loss, and type of hearing device utilized.

RESULTS

Twenty-five percent of adolescents scored above the clinical cutoff on at least one of the depression and/or anxiety measures, with 10% scoring in the elevated range on both measures. Specifically, 17% scored above the cutoff on the PHQ-8 and 16% scored in the clinically significant range for the GAD-7. An additional 30 and 21% scored in the at-risk range for depression and anxiety, respectively. Older adolescents were more likely to score within the elevated range for depression (r = 0.232, p = 0.026). Also, adolescents with severe to profound hearing loss had higher rates of depression and anxiety.

CONCLUSIONS

Integration of mental health screening is needed in otology and audiology practices both to identify those who require psychological support and to provide appropriate treatment to reduce long-term impact of hearing loss on quality of life and mental health functioning in adolescents.

Predictors of Quality of Life Improvement with Escitalopram and Adjunctive Aripiprazole in Patients with Major Depressive Disorder: A CAN-BIND Study Report

BACKGROUND

Non-response to first-line treatment for major depressive disorder (MDD) is common; for such individuals, quality of life (QoL) impairments can be severe. Identifying predictors of QoL changes may support the management of cases with persistent depressive symptoms despite adequate initial pharmacological/psychological treatment.

OBJECTIVE

The present study aimed to explore predictors of domain-specific QoL improvement following adjunctive aripiprazole treatment for inadequate response to initial antidepressant therapy.

METHODS

We evaluated secondary QoL outcomes from a CAN-BIND (Canadian Biomarker Integration Network in Depression) study in patients with MDD who did not respond to an initial 8 weeks of escitalopram and received a further 8 weeks of adjunctive aripiprazole (n = 96). Physical, psychological, social, and environmental QoL domains were assessed using the World Health Organization QoL Scale Brief Version (WHOQOL-BREF). Clinician-rated depressive symptoms were assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS). Functioning was measured with the Sheehan Disability Scale (SDS). Satisfaction with medication was assessed with a single item from the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF). Exploratory t-tests were used to describe domain score changes. A hierarchical linear regression was used to explore demographic, clinical, and treatment-related predictors of improvement.

RESULTS

Across domains, QoL improved with adjunctive aripiprazole treatment. Satisfaction with medication and MADRS and SDS scores similarly improved. Symptom reduction was a predictor for positive change to physical and psychological QoL; functioning improvements were predictive of increases to all QoL domains. Satisfaction with medication predicted improvements to physical and psychological domains, whereas number of medication trials was a predictor of worsening QoL in the physical domain.

CONCLUSION

The final model explained the most variance in psychological (68%) and physical (67%) QoL. Less variance was explained for environmental (43%) and social QoL (33%), highlighting a need for further exploration of predictors in these domains. Strategies such as functional remediation may have potential to support QoL for individuals with persistent depressive symptoms.

CLINICAL TRIALS REGISTRY

ClinicalTrials.gov identifier: NCT016557.

Depressive and anxiety disorders in concert-A synthesis of findings on comorbidity in the NESDA study

BACKGROUND

Comorbidity of depressive and anxiety disorders is common and remains incompletely comprehended. This paper summarizes findings from the Netherlands Study of Depression and Anxiety (NESDA) regarding prevalence, temporal sequence, course and longitudinal patterns; sociodemographic, vulnerability and neurobiological indicators; and functional, somatic and mental health indicators of comorbidity.

METHODS

Narrative synthesis of earlier NESDA based papers on comorbidity (n=76).

RESULTS

Comorbidity was the rule in over three-quarter of subjects with depressive and/or anxiety disorders, most often preceded by an anxiety disorder. Higher severity and chronicity characterized a poorer comorbidity course. Over time, transitions between depressive and anxiety disorders were common. Consistent comorbidity risk indicators in subjects with depressive and anxiety disorders were childhood trauma, neuroticism and early age of onset. Psychological vulnerabilities, such as trait avoidance tendencies, were more pronounced in comorbid than in single disorders. In general, there were few differences in biological markers and neuroimaging findings between persons with comorbid versus single disorders. Most functional, somatic, and other mental health indicators, ranging from disability to cardiovascular and psychiatric multimorbidity, were highest in comorbid disorders.

LIMITATIONS

The observational design of NESDA limits causal inference. Attrition was higher in comorbid relative to single disorders.

CONCLUSIONS

As compared to single disorders, persons with comorbid depressive and anxiety disorders were characterized by more psychosocial risk determinants, more somatic and other psychiatric morbidities, more functional impairments, and poorer outcome. These results justify specific attention for comorbidity of depressive and anxiety disorders, particularly in treatment settings.

Polybrominated Diphenyl Ether Serum Concentrations and Depressive Symptomatology in Pregnant African American Women

(1) Polybrominated diphenyl ethers (PBDEs) were widely produced in the United States until 2004 but remain highly persistent in the environment. The potential for PBDEs to disrupt normal neuroendocrine pathways resulting in depression and other neurological symptoms is largely understudied. This study examined whether PBDE exposure in pregnant women was associated with antenatal depressive symptomatology. (2) Data were collected from 193 African American pregnant women at 8–14 weeks gestation. Serum PBDEs and depressive symptoms were analyzed and a mixture effect was calculated. (3) Urban pregnant African American women in the Southeastern United States had a high risk of depression (27%) compared to the National average. Increased levels of PBDEs were found. BDE-47 and -99 exposures are significantly associated with depressive symptomatology in the pregnant cohort. The weighted body burden estimate of the PBDE mixture was associated with a higher risk of mild to moderate depression using an Edinburgh Depression Scale cutoff score of ≥10 (OR = 2.93; CI 1.18, 7.82). (4) Since antenatal depression may worsen in postpartum, reducing PBDE exposure may have significant clinical implications.

Anxiety disorders

Anxiety disorders form the most common group of mental disorders and generally start before or in early adulthood. Core features include excessive fear and anxiety or avoidance of perceived threats that are persistent and impairing. Anxiety disorders involve dysfunction in brain circuits that respond to danger. Risk for anxiety disorders is influenced by genetic factors, environmental factors, and their epigenetic relations. Anxiety disorders are often comorbid with one another and with other mental disorders, especially depression, as well as with somatic disorders. Such comorbidity generally signifies more severe symptoms, greater clinical burden, and greater treatment difficulty. Reducing the large burden of disease from anxiety disorders in individuals and worldwide can be best achieved by timely, accurate disease detection and adequate treatment administration, scaling up of treatments when needed. Evidence-based psychotherapy (particularly cognitive behavioural therapy) and psychoactive medications (particularly serotonergic compounds) are both effective, facilitating patients' choices in therapeutic decisions. Although promising, no enduring preventive measures are available, and, along with frequent therapy resistance, clinical needs remain unaddressed. Ongoing research efforts tackle these problems, and future efforts should seek individualised, more effective approaches for treatment with precision medicine.

Trends in self-reported psychological distress among college and university students from 2010 to 2018

BACKGROUND

An increase in reported psychological distress, particularly among adolescent girls, is observed across a range of countries. Whether a similar trend exists among students in higher education remains unknown. The aim of the current study was to describe trends in self-reported psychological distress among Norwegian college and university students from 2010 to 2018.

METHODS

We employed data from the Students' Health and Wellbeing Study (SHoT), a nationwide survey for higher education in Norway including full-time students aged 18-34. Numbers of participants (participation rates) were n = 6065 (23%) in 2010, n = 13 663 (29%) in 2014 and n = 49 321 (31%) in 2018. Psychological distress was measured using the Hopkins Symptom Checklist-25 (HSCL-25).

RESULTS

Overall, a statistically significant increase in self-reported psychological distress was observed over time across gender and age-groups. HSCL-25 scores were markedly higher for women than for men at all time-points. Effect-size of the mean change was also stronger for women (time-by-gender interaction: χ2 = 70.02, df = 2, p < 0.001): in women, mean HSCL-25 score increased from 1.62 in 2010 to 1.82 in 2018, yielding a mean change effect-size of 0.40. The corresponding change in men was from 1.42 in 2010 to 1.53 in 2018, giving an effect-size of 0.26.

CONCLUSIONS

Both the level and increase in self-reported psychological distress among Norwegian students in higher education are potentially worrying. Several mechanisms may contribute to the observed trend, including changes in response style and actual increase in distress. The relative low response rates in SHoT warrant caution when interpreting and generalising the findings.

Quality of life of women with untreated vulval lichen sclerosus assessed with vulval quality of life index (VQLI)

BACKGROUND/OBJECTIVE

The diagnosis of vulval lichen sclerosus (VLS) is often delayed, and little is known about quality of life (QoL) of women with it prior to receiving diagnosis and treatment. This study aimed to investigate the impact on QoL on patients with previously untreated VLS using the Vulval Quality of Life Index (VQLI).

METHODS

A prospective cross-sectional survey of patients attending a dermato-gynaecology practice in Sydney, Australia from March 2018 to November 2019. Patients with a new biopsy-proven diagnosis of VLS not previously commenced on topical corticosteroid treatment were invited to complete the VQLI.

RESULTS

A total of 68 participants with median age of 58 (interquartile range, IQR 48-67) years. Median symptom duration was 24 (IQR 11-60) months. Scarring was present in 53% of participants. The median total score was 13.5 (IQR 7.5-22.0), global score 1.0 (IQR 1.0-2.0). Twelve per cent had nil to minimal effect on QoL, 38% had a mild effect on QoL, 28% had a moderate effect on QoL, 22% had a severe effect on QoL, and none had a very severe effect on QoL. The highest-scoring domains were symptoms, followed by sexuality, anxiety and activities of daily living.

CONCLUSION

There was significant impairment in all QoL areas of women with untreated VLS. Most experienced moderate-to-severe impairment as a result of the disease and approximately half had already developed scarring at the time of diagnosis. The findings emphasise the importance of improved awareness, early diagnosis and early commencement of treatment in VLS.

Depressive and anxiety symptoms in early childhood education teachers: Relations to professional well-being and absenteeism

This study investigated how early childhood education teachers' (N = 444) depressive and anxiety symptoms predicted their professional well-being outcomes and absenteeism over the course of one school year in Ghana. Higher anxiety and depressive symptoms predicted lower job motivation and job satisfaction and higher levels of emotional exhaustion at the end of the school year. Increased depressive symptoms were further associated with more days absent over the course of the school year. Findings point to the importance of considering teachers' mental health for early educational quality. Implications for policy and practice are discussed.

Demographic and health-related factors associated with reduced work functioning in people with moderate medically unexplained physical symptoms: a cross-sectional study

BACKGROUND

Medically unexplained physical symptoms (MUPS) are a leading cause of reduced work functioning. It is not known which factors are associated with reduced work functioning in people with moderate MUPS. Insight in these factors can contribute to prevention of reduced work functioning, associated work-related costs and in MUPS becoming chronic. Therefore, the aim of this study was to identify which demographic and health-related factors are associated with reduced work functioning, operationalized as impaired work performance and absenteeism, in people with moderate MUPS.

METHODS

Data of 104 participants from an ongoing study on people with moderate MUPS were used in this cross-sectional study. Ten independent variables were measured at baseline to determine their association with reduced work functioning: severity of psychosocial symptoms (four domains, measured with the Four-Dimensional Symptom Questionnaire), physical health (RAND 36-Item Health Survey), moderate or vigorous physical activity (Activ8 activity monitor), age, sex, education level and duration of complaints. Two separate multivariable linear regression analyses were performed with backward stepwise selection, for both impaired work performance and absenteeism.

RESULTS

Absenteeism rate rose with 2.5 and 0.6% for every increased point on the Four-Dimensional Symptom Questionnaire for domain 'depression' (B = 0.025, SE = 0.009, p = .006) and domain 'somatization' (B = 0.006, SE = 0.003, p = .086), respectively. An R² value of 0.118 was found. Impaired work performance rate rose with 0.2 and 0.5% for every increased point on the Four-Dimensional Symptom Questionnaire for domain 'distress' (B = 0.002, SE = 0.001, p = .084) and domain 'somatization' (B = 0.005, SE = 0.001, p < .001), respectively. An R² value of 0.252 was found.

CONCLUSIONS

Severity of distress, probability of a depressive disorder and probability of somatization are positively associated with higher rates of reduced work functioning in people with moderate MUPS. To prevent long-term absenteeism and highly impaired work performance severity of psychosocial symptoms seem to play a significant role. However, because of the low percentage of explained variance, additional research is necessary to gain insight in other factors that might explain the variance in reduced work functioning even better.

The role of borderline personality disorder symptoms on absenteeism & work performance in the Netherlands Study of Depression and Anxiety (NESDA)

BACKGROUND

Symptoms of borderline personality disorder (BPD) were previously found to be associated with decreased work performance, even after controlling for depressive and anxiety disorders. Furthermore, co-occurrence of BPD and affective disorders is common. Therefore, we examined the effect of BPD symptoms on occupational functioning in workers with affective disorders.

METHODS

Healthy workers (n = 287), workers with current depression/anxiety only (n = 195), workers with BPD symptoms only (n = 54), and workers with both depression/anxiety and BPD symptoms (n = 103) were selected from the Netherlands Study of Depression and Anxiety (NESDA). Both a categorical and dimensional approach were used to cross-sectionally study the effect of BPD symptoms on work performance and absenteeism.

RESULTS

Compared to healthy controls, all symptomatic groups had impaired occupational functioning. Workers with current depression/anxiety had higher long-term absenteeism (OR = 3.59; 95%CI:1.83-7.02) and impaired work performance (OR = 7.81; 95%CI:4.44-13.73), workers with BPD symptoms only had higher impaired work performance (OR = 6.02 95%CI:2.76-13.09), and workers with both depression/anxiety and BPD symptoms had higher long-term absenteeism (OR = 3.66 95%CI:1.69-7.91) and impaired work performance (OR = 10.41 95%CI:5.38-20.15). No difference was found between the (symptomatic) groups. In the dimensional analysis, all associations between BPD symptoms and occupational measures disappeared when depressive symptoms were added. Depressive and BPD symptoms were highly correlated (r = .67).

CONCLUSIONS

Our findings confirm that both affective disorders and BPD symptoms are associated with occupational dysfunction. The effect of BPD symptoms however, seems mediated by depressive symptoms. This would suggest that focusing on affective symptoms in occupational health may be effective to improve occupational functioning in persons with BPD.

Failing Is Derailing: The Underperformance as a Stressor Model

Job performance and job stress are widely studied phenomena in occupational research. However, most literatures on the relationship between work stress and job performance conceptualize job stress as an antecedent of performance, in line with the stress-performance framework, and do not examine what happens to the well-being of the employees after the performance was appraised as poor. In the current theoretical paper, I argue that task underperformance is a source of stress (i.e., stressor) for the employee and, as such, can affect a wide range of employee outcomes. Task underperformance is conceptualized as comprised of two main types: acute/episodic underperformance, such as a mistake or an accident (e.g., medical error and service failure), and chronic task underperformance, such as not achieving the expected work products over time, with an interplay between these types. The source of the appraisal (objective, supervisor-rated, and self-rated underperformance) is also considered. Several disjoint literatures are then integrated in order to explain how underperformance is expected to result in subsequent decrements to employee well-being. At the chronic underperformance level, the following literatures are included: self-efficacy, negative effects of performance feedback, and stress experienced when the basic need for competency is frustrated or when underperformance presents a threat to the self-image. At the acute/episodic level, affective and cognitive outcomes are explored, and examples are drawn from several industries including service failures and medical errors. The interplay between the two types of underperformance, acute/episodic and chronic, is discussed, and then relevant moderators are offered. One notable moderator is the occupation-level consequences of error, which likely affects most if not all outcomes. Finally, the discussion includes potential theoretical and practical implications for this conceptualization, as well as some methodological considerations for future research in this area.

The associations between childhood trauma and work functioning in adult workers with and without depressive and anxiety disorders

BACKGROUND

To examine the association between childhood trauma and work functioning, and to elucidate to what extent this association can be accounted for by depression and/or anxiety.

METHODS

Data of 1,649 working participants were derived from the Netherlands Study of Depression and Anxiety (NESDA, n = 2,981). Childhood trauma (emotional neglect, psychological, physical, and sexual abuse before age 16) was assessed with a structured interview and work functioning, in terms of absenteeism and presenteeism, with the Health and Labor Questionnaire Short Form (SF-HLQ) and the World Health Organization Disability Assessment Schedule II (WHODAS-II), respectively. Depressive and/or anxiety disorders were assessed with the Composite Interview Diagnostic Instrument (CIDI). Mediation analyses were conducted.

RESULTS

At baseline, 44.8% reported to have experienced childhood trauma. Workers with the highest childhood trauma level showed significantly (p < 0.001) more absenteeism as well as more presenteeism. Mediation analyses revealed that indirect effects between the childhood trauma index and both work indices were significantly mediated by current depressive disorder (p = 0.023 and p < 0.001, respectively) and current comorbid depression-anxiety (p = 0.020 and p < 0.001, respectively), with the latter accounting for the largest effects (PM = 0.23 and PM = 0.29, respectively). No significant mediating role in this relationship was found for current anxiety disorder and remitted depressive and/or anxiety disorder.

CONCLUSIONS

Persons with childhood trauma have significantly reduced work functioning in terms of absenteeism and presenteeism. This seems to be largely accounted for by current depressive disorders and current comorbid depression-anxiety.

Blended Care-Cognitive Behavioral Therapy for Depression and Anxiety in Real-World Settings: Pragmatic Retrospective Study

Background

The past few decades saw considerable advances in research and dissemination of evidence-based psychotherapies, yet available treatment resources are not able to meet the high need for care for individuals suffering from depression or anxiety. Blended care psychotherapy, which combines the strengths of therapist-led and internet interventions, can narrow this gap and be clinically effective and efficient, but has rarely been evaluated outside of controlled research settings.

Objective

This study evaluated the effectiveness of a blended care intervention (video-based cognitive behavior therapy and internet intervention) under real-world conditions.

Methods

This is a pragmatic retrospective cohort analysis of 385 participants with clinical range depression and/or anxiety symptoms at baseline, measured using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), who enrolled in blended care psychotherapy treatment. Participants resided in the United States and had access to the blended care intervention as a mental health benefit offered through their employers. Levels of depression and anxiety were tracked throughout treatment. Hierarchical linear modeling was used to examine the change in symptoms over time. The effects of age, gender, and providers on participants’ symptom change trajectories were also evaluated. Paired sample t-tests were also conducted, and rates of positive clinical change and clinically significant improvement were calculated.

Results

The average depression and anxiety symptoms at 6 weeks after the start of treatment were 5.94 and 6.57, respectively. There were significant linear effects of time on both symptoms of depression and anxiety (β=–.49, P<.001 and β=–.64, P<.001). The quadratic effect was also significant for both symptoms of depression and anxiety (β=.04, P<.001 for both), suggesting a decelerated decrease in symptoms over time. Approximately 73% (n=283) of all 385 participants demonstrated reliable improvement, and 83% (n=319) recovered on either the PHQ-9 or GAD-7 measures. Large effect sizes were observed on both symptoms of depression (Cohen d=1.08) and of anxiety (d=1.33).

Conclusions

Video blended care cognitive behavioral therapy interventions can be effective and efficient in treating symptoms of depression and anxiety in real-world conditions. Future research should investigate the differential and interactive contribution of the therapist-led and digital components of care to patient outcomes to optimize care.

Cognitive functioning, sleep quality, and work performance in non-clinical burnout: The role of working memory

We investigated the relationship between cognitive functioning, work performance, and sleep in non-clinical burnout. In a working population, an online survey was conducted with additional online neuropsychological tests of varying complexity, measuring attention and different components of working memory, of which the coordinating subcomponent the ‘Central Executive’ is thought to be the most vulnerable to stress. Results indicate that non-clinical burnout is associated with more—though not severe—sleep problems, more depressive complaints, impaired work performance, and with both subjective and objective cognitive impairments. Compared with healthy respondents (N = 107), people with non-clinical burnout (N = 17) had a significantly poorer performance on the tests of the visuospatial sketchpad and the Central Executive of the working memory. Our study also indicates that more complex tests may be more sensitive in detecting cognitive dysfunction in non-clinical burnout. Furthermore, a relationship was found between dual-task performance and work performance. Regarding to sleep quality, in our sample of people with non-clinical burnout, there were no severe sleep problems. In the entire sample, however, insomnia was significantly related to subjective, but not objective, cognitive functioning, and also not to work performance.

Interaction between anxiety and depression on suicidal ideation, quality of life, and work productivity impairment: Results from a representative sample of the Lebanese population

PURPOSE

To assess the association between the interaction of anxiety and depression on the suicidal ideation, quality of life (QOL), and work productivity/impairment in Lebanon.

DESIGN

Cross-sectional.

METHODS

1487 participants were enrolled between November 2017 and March 2018.

RESULTS

The interaction of anxiety and depression (β = .101), higher depression alone (β = .021), higher anxiety traits (STAI-B) (β = .007) were associated with higher suicidal ideation. Higher depression (β = 1.177), having more anxiety traits (STAI-B) (β = .485) and higher anxiety (STAI-A) (β = .298) were associated with higher activity impairment. Higher depression, higher anxiety traits and state, were associated with lower mental and physical QOL.

PRACTICE IMPLICATIONS

Screening for anxiety and depression can help clinicians improve patients' QOL and work productivity and decrease the suicidal ideation risk.

Prompt Mental Health Care (PMHC): work participation and functional status at 12 months post-treatment

BACKGROUND

Anxiety and depression are associated with substantial functional impairment. Prompt Mental Health Care (PMHC), the Norwegian adaptation of IAPT is currently piloted across Norway, as a means to improve access to evidence-based care for adults with anxiety disorders (including subthreshold cases) and minor to moderate depression. The aims of the current paper were to examine the change in work status and functional status from pre- to post-treatment and 12 months post-treatment among clients at the first 12 PMHC pilot sites, and whether degree of change differed across sociodemographic characteristics.

METHODS

A prospective cohort design was used, including working age clients receiving treatment between October 2014 and December 2016 (n = 1446, participation rate = 61%). Work status and functional status were self-reported, the latter by the Work and Social Adjustment Scale (WSAS). Changes in work status and WSAS score were examined through multilevel models based on maximum likelihood estimation. Likelihood ratio tests were performed to determine whether the interaction between time and the respective background variables were statistically significant.

RESULTS

A substantial increase in regular work participation was observed from pre- to post-treatment, which further had increased at 12 months post-treatment. The increase was driven by a corresponding reduction in proportion of clients working and receiving benefits (OR 0.38 [0.29-0.50] baseline to final treatment, OR = 0.19 [0.12-0.32] final treatment to 12-months post-treatment), while no statistically significant change was observed in proportion out of work. Large improvement (ES = - 0.89) in WSAS score was observed from pre- to post treatment. WSAS score at 12 months post-treatment remained at the post-treatment level.

CONCLUSIONS

Previous research has shown substantial symptom improvement among clients receiving treatment in PMHC. The current findings indicate that PMHC might also be able to aid adults struggling with mild to moderate anxiety and depression in returning to usual level of functioning. The degree to which the observed improvements are attributable to the treatment need nonetheless to be confirmed in a trial including a control group and with more complete follow-up data from registries.

Depressive Symptomatology, Presenteeism Productivity, and Quality of Life: A Moderated Mediation Model

: In this study, we intend to test if presenteeism productivity influences the relationship between depressive symptoms and quality of life and also if this relation is conditional upon levels of information processing speed. Data were collected from 231 participants who completed a neuropsychological test and self-reported measures. Results revealed a significant indirect effect and a significant moderation effect. The association between depressive symptoms and presenteeism productivity was moderated by information processing speed only in their medium and high levels. Our findings suggest that individuals with higher levels of processing speed may have more difficulty in focusing on work without being distracted by health problems. The present investigation has made a significant contribution to the existing literature about cognitive function and productivity in workers with depressive symptomatology and its effects on their quality of life.

Protective and risk factors for depressive mood and anxiety against occupational stress: examining temperament character and coping strategy among civil servants

This study investigated protective and risk factors for depressive mood and anxiety against occupational stress, including temperament character and coping strategy, among civil servants. We administered a questionnaire that included demographic factors and psychological scales to 1197 Korean civil servants. High levels of occupational stress, temperaments of novelty seeking and harm avoidance, a character of cooperativeness, and using emotion-focused coping were risk factors for depressive mood, while living with a partner, having a character of self-directedness, and using problem-focused strategies were protective factors. Additionally, female gender, high level of occupational stress, and temperaments of novelty seeking and harm avoidance were risk factors for anxiety, while having a character of self-directedness was a protective factor. Assessment of temperament character and training on effective coping strategies may help address depressive mood and anxiety for civil servants.

Resilience as a Protective Factor for Depressive Mood and Anxiety among Korean Employees

BACKGROUND

This study aimed to investigate resilience as a protective factor for depressive mood and anxiety among Korean employees.

METHODS

Participants were employees of eight private and local government organizations in Korea, aged 19 to 65 years. A self-report questionnaire that included items on resilience, job stress, levels of depression and anxiety, and socio-demographic factors, was administered to 1,079 Korean employees, with 1,076 valid responses. We performed hierarchical linear regression analyses with the levels of depression and anxiety scores as dependent variables.

RESULTS

Being women and having a high level of job stress were associated with greater depressive mood and anxiety. In contrast, resilience was negatively related to depressive mood and anxiety, after adjusting for demographic variables and the level of job stress. Among the five factors for resilience, "support" and "hardiness" were protective factors for depressive mood and anxiety after adjusting for demographic variables and the level of job stress.

CONCLUSION

Based on the results of the current study, we suggest that focusing on the resilience of employees, especially on "support" and "hardiness," factors as well as developing and engaging in interventions that increase resilience in the workplace, can protect against depressive mood and anxiety, especially for those with high levels of job stress.

Neuro magnifico! An exploratory study critically reviewing news text reporting of anxiety-related work performance strengths, challenges and support measures

BACKGROUND

Progressive workplaces should be aware of emerging neurodiversity related issues. People are sharing their narratives of high functioning anxiety in a variety of forums. Despite news text reporting upon this phenomenon, the concept has managed to escape a research spotlight.

OBJECTIVE

To critically investigate the evidence base of news article reporting of anxiety-related work performance strengths, challenges and support measures.

METHODS

Thematic analysis was applied to news texts derived from CrossSearch database and internet enquiries and journal articles obtained from Scopus, Medline and Science Direct databases.

RESULTS

The analysis of eight news texts and 36 journal articles produced evidence-based themes including those of work performance strengths (quality, quantity, creativity) challenges (overreaching, perfectionism, overthinking, communication) and support measures (medical, cognitive, physical, flexibility).

CONCLUSION

This investigative review reveals that anxiety-related work performance strengths, challenges and support measures as identified within news text reporting of the high functioning anxiety concept have at least some basis in the literature. It might therefore be the case that organizations who invest in supporting employees who identify with high functioning dimensions of their anxiety disorders are the ones who are ultimately rewarded with work performance advantages.

An evaluation of large group cognitive behaviour therapy with mindfulness (CBTm) classes

BACKGROUND

Ensuring equitable and timely access to Cognitive Behaviour Therapy (CBT) is challenging within Canada's service delivery model. The current study aims to determine acceptability and effectiveness of 4-session, large, Cognitive Behaviour Therapy with Mindfulness (CBTm) classes.

METHODS

A retrospective chart review of adult outpatients (n = 523) who attended CBTm classes from 2015 to 2016. Classes were administered in a tertiary mental health clinic in Winnipeg, Canada and averaged 24 clients per session. Primary outcomes were (a) acceptability of the classes and retention rates and (b) changes in anxiety and depressive symptoms using Generalized Anxiety Disorder 7-item (GAD-7) and Patient Health Questionnaire 9-item (PHQ-9) scales.

RESULTS

Clients found classes useful and > 90% expressed a desire to attend future sessions. The dropout rate was 37.5%. A mixed-effects linear regression demonstrated classes improved anxiety symptoms (GAD-7 score change per class = - 0.52 [95%CI, - 0.74 to - 0.30], P < 0.001) and depressive symptoms (PHQ-9 score change per class = - 0.65 [95%CI, - 0.89 to - 0.40], P < 0.001). Secondary analysis found reduction in scores between baseline and follow-up to be 2.40 and 1.98 for the GAD-7 and PHQ-9, respectively. Effect sizes were small for all analyses.

CONCLUSIONS

This study offers preliminary evidence suggesting CBTm classes are an acceptable strategy to facilitate access and to engage and maintain clients' interest in pursuing CBT. Clients attending CBTm classes experienced improvements in anxiety and depressive symptoms. Symptom improvement was not clinically significant. Study limitations, such as a lack of control group, should be addressed in future research.

Meaning in life buffers the association between clinical anxiety and global maladjustment in participants with common mental disorders on sick leave

An important goal of mental health specialists is to improve the quality of life and the adaptation of people with common mental disorders on sick leave. Meaning in life is a protective factor for people adjusting to distress and negative events. This study explores the buffering role of meaning in life in the relationship between clinical anxiety or negative affect and maladjustment in participants with common mental disorders on sick leave. The sample was 167 participants with Adjustment, Anxiety and, Depressive Disorders; n = 115 were women and n = 52 men. Participants' mean age M = 42.16 (SD = 9.91) years. We performed zero-order correlations and hierarchical regression analyses. Meaning in life moderated and buffered the association between clinical anxiety or negative affect and global maladjustment to daily life. These findings suggest that Meaning in life is a relevant variable in the adjustment of common mental disorders on sick leave.

Effects on work ability, job strain and quality of life of monitoring depression using a self-assessment instrument in recurrent general practitioner consultations: A randomized controlled study

BACKGROUND:

Depression reduces individuals’ function and work ability and is associated with both frequent and long-term sickness absence.

OBJECTIVE:

Investigate if monitoring of depression course using a self-assessment instrument in recurrent general practitioner (GP) consultations leads to improved work ability, decreased job strain, and quality of life among primary care patients.

METHODS:

Primary care patients n = 183, who worked. In addition to regular treatment (control group), intervention patients received evaluation and monitoring and used the MADRS-S depression scale during GP visit at baseline and at visits 4, 8, and 12 weeks. Work ability, quality of life and job strain were outcome measures.

RESULTS:

Depression symptoms decreased in all patients. Significantly steeper increase of WAI at 3 months in the intervention group. Social support was perceived high in a significantly higher frequency in intervention group compared to control group.

CONCLUSIONS:

Monitoring of depression course using a self-assessment instrument in recurrent GP consultations seems to lead to improved self-assessed work ability and increased high social support, but not to reduced job strain or increased quality of life compared to TAU. Future studies concerning rehabilitative efforts that seek to influence work ability probably also should include more active interventions at the workplace.

Differential Experimental Effects of a Short Bout of Walking, Meditation, or Combination of Walking and Meditation on State Anxiety Among Young Adults

INTRODUCTION

Single bouts of aerobic exercise and meditation have been shown to improve anxiety states. Yet to be evaluated in the literature, we sought to examine the effects of a single, short bout of aerobic exercise or meditation, as well as exercise and meditation combined on state anxiety among young adults.

DESIGN

Randomized controlled trial.

SETTING

University.

SUBJECTS

Participants (N = 110, mean age = 21.4 years) were randomly assigned to walk, meditate, walk then meditate, meditate then walk, or to sit (inactive control).

MEASURES

All walking and meditation bouts were 10 minutes in duration. Participants' state anxiety was monitored before and after the intervention using the State Trait Anxiety Inventory questionnaire.

RESULTS

Significant group × time interaction effects were observed ( P = .01). Post hoc paired t tests revealed that state anxiety significantly decreased from baseline to postintervention in the meditation ( P = .002), meditation then walk ( P = .002), and walk then meditation ( P = .03) groups but not the walk ( P = .75) or control ( P = .45) groups.

CONCLUSION

Meditation (vs a brisk walk) may be a preferred method of attenuating anxiety symptomology. Individuals desiring the health benefits associated with aerobic exercise may achieve additional anxiolytic benefits if they employ a brief meditation session before or after exercising.

Prediction of functional outcome in young patients with a recent-onset psychiatric disorder: Beyond the traditional diagnostic classification system

A critical research goal is to identify modifiable risk factors leading to functional disabilities in young psychiatric patients. The authors developed a multidimensional trans-diagnostic predictive model of functional outcome in patients with the recent-onset of a psychiatric illness. Baseline clinical, psychosis-risk status, cognitive, neurological-soft-signs measures, and dopamine-related-gene polymorphisms (DRD1-rs4532, COMT-rs165599, and DRD4-rs1800955) were collected in 138 young non-psychotic outpatients. 116 individuals underwent follow-up (mean=2.2years, SD=0.9) examination. A binary logistic model was used to predict low-functioning status at follow-up as defined by a score lower than 65 in the social occupational functioning assessment scale. A total of 54% of patients experiences low functioning at follow-up. Attention, Avolition, and Motor-Coordination subscale were significant predictors of low-functioning with an accuracy of 79.7%. A non-significant trend was found for a dopamine-related-gene polymorphism (DRD1-rs4532). The model was independent of psychotic-risk status, DSM-diagnosis, and psychotic conversion. A trans-diagnostic approach taking into account specific neurocognitive, clinical, and neurological information has the potential to identify those individuals with low-functioning independent of DSM diagnosis or the level of psychosis-risk. Specific early interventions targeting modifiable risk factors and emphasize functional recovery in young psychiatric samples, independent of DSM-diagnosis and psychosis-risk, are essential.

The effects on anxiety and quality of life of breast cancer patients following completion of the first cycle of chemotherapy

OBJECTIVES

Breast cancer patients as part of their treatment need to undergo various forms of chemotherapy. This is considered as a burdensome experience for many patients often leading to significant levels of anxiety. The aim of the study was to explore the anxiety levels and any correlations to the quality of life of women with breast cancer that were undergoing chemotherapy.

METHODS

This was a cross-sectional study utilizing an explanatory sequential design. Data were collected from 355 women with breast cancer with the Self Anxiety Scale, the EORTC QLQ-C30, the EORTC QLQ-BR23 and sociodemographic questionnaires. Further insight to patients' experiences was given through 12 in-depth interviews.

RESULTS

Anxiety scores ranged between 24 and 75 (45.7 ± 10.11), with 44% reporting serious or/and intense anxiety. The results revealed statistically significant differences on patients' anxiety levels depending on their source of support. Overall, patients' global health-related quality of life was found to be low to average 55.91 ± 17.94. The results showed low emotional functioning (49.30 ± 29.12), low role functions (56.34 ± 27.50) and low sexual functioning (24.93 ± 20.75). Patients also reported experiencing problems with fatigue (49.04 ± 29.12), insomnia (44.32 ± 32.97), hair loss (48.25 ± 38.32) and arm symptoms (36.53 ± 23.71). Patients being solely supported by the family experienced higher anxiety levels (p < 0.001) and lower quality of life (p < 0.001). There was a statistically significant negative correlation between anxiety and quality of life (r = -0.623, p < 0.001). Statistically significant differences were also found in relation to demographics, anxiety and quality of life. The interviews provided further evidence on the impact of anxiety on patients' lives.

CONCLUSION

The time following the completion of the first cycle of chemotherapy is associated with anxiety and lower quality of life levels in breast cancer patients. Healthcare providers should consider the supportive healthcare needs from the beginning of chemotherapy in patients to optimize their conventional and supportive healthcare outcomes.

A 10-year evaluation on adolescents with anxiety disorders: are they at risk of bipolarity?

OBJECTIVE

Anxiety disorders are the most frequent disorders comorbid with bipolar disorder (BD) often preceding the BD onset. The presence of comorbid anxiety in patients diagnosed with BD is associated with worsening of their BD symptoms, increased risky behaviour, decreased response to pharmacological treatment and deterioration in their quality of life and global functioning. The aim of this study was to investigate if anxiety disorders in adolescence could be considered as predictors of BD.

METHODS

Adolescents with a primary anxiety disorder were recruited consecutively from the Mood and Anxiety Disorders Unit, Department of Neuroscience, University of Turin. Subjects were evaluated for Axis I psychiatric disorders, family history and global functioning, and followed up on average 10 years later.

RESULTS

A total of 29 patients (59.2%) were male and the mean age at the onset of anxiety disorder was 16.3 (±0.8). Ten years following recruitment, 11 (22.4%) patients fulfilled the criteria for BD. Of them, 10 (90.9%) had a family history of BD and four (36.4%) presented a comorbid substance use disorder.

CONCLUSIONS

Our study shows that both family history of BD and substance use disorder, in adolescent patients with a primary anxiety disorder, should be considered as potential predictors of BD onset.

Patient-Reported Outcomes of Quality of Life, Functioning, and GI/Psychiatric Symptom Severity in Patients with Inflammatory Bowel Disease (IBD)

BACKGROUND

Patients with inflammatory bowel disease (IBD) are at risk for psychiatric disorders that impact symptom experience and health-related quality of life (HRQOL). Therefore, comprehensive biopsychosocial assessments should be considered in ambulatory care settings. Patient-Reported Outcomes Measurement Information System (PROMIS) measures created by the National Institutes of Health have shown construct validity in a large IBD internet-based cohort, but their validity in ambulatory settings has not been examined. We sought to validate PROMIS patient-reported measures of HRQOL, functioning, and psychiatric symptom severity at a tertiary IBD clinic.

METHODS

Adult patients (n = 110) completed the PROMIS Global Health scale, PROMIS-29, SF-12, and WHODAS 2.0. Pearson's correlation coefficients (r) determined the relationships between scores to validate the PROMIS Global Health Physical and Mental metrics, compared with the SF-12 and WHODAS 2.0. We compared these measures by disease subtype of Crohn's disease or ulcerative colitis.

RESULTS

PROMIS measures were highly correlated (r range = 0.64-0.82) with standard measures of HRQOL and functioning. On the PROMIS Global Health measures, 20.9% had impaired physical health, and 13.7% had impaired mental health. Impairments were reported in pain interference (20% of patients), anxiety (18.2%), satisfaction with social role (15.5%), physical functioning (10.9%), fatigue (10%), depression (7.3%), and sleep disturbance (5.5%). Patients with Crohn's disease had worse scores than those with ulcerative colitis on measures of the global physical health (P = 0.027), physical functioning (P = 0.047), and pain interference (P = 0.0009).

CONCLUSIONS

PROMIS instruments provide valid assessment of HRQOL and functioning in ambulatory adults with IBD. Of note, patients with Crohn's disease demonstrated significantly worse impairments than those with ulcerative colitis.

From neurological soft signs to functional outcome in young individuals in treatment with secondary services for non-psychotic disorders: a path analysis

BACKGROUND

Functional decline among patients with mental illness is not unique to individuals with psychotic disorders. Despite this, research on early predictors of functional outcome mainly focused on individuals thought to have an 'at risk mental state' (ARMS) for psychosis. There is evidence suggesting that certain early vulnerability markers, such as neurological soft signs (NSS), may explain variability in functional outcomes independent of the level of psychosis risk and the traditional diagnostic classification.

METHOD

Structural equation modeling was applied to baseline data from a prospective longitudinal study of 138 young individuals in treatment with secondary services for non-psychotic disorders. We evaluated theoretically based models of pathways to functional outcome starting from NSS. The intervening variables were established according to previous evidence and drawn from two general categories: cognition (neuro- and social-) and negative symptoms (expressive and experiential).

RESULTS

A final trimmed model was a single path running from NSS to neurocognition to experiential negative symptoms to outcome. It could not be improved by adding or dropping connections that would change the single path to multiple paths. The indirect effect from NSS to outcome was significant. The validity of the model was independent of the ARMS status and the psychiatric diagnosis.

CONCLUSIONS

Our results provide evidence for a single pathway model in which the starting and intervening variables represent modifiable trans-diagnostic therapeutic targets to improve functional trajectories in young individuals with a recent-onset psychiatric diagnosis and different levels of psychosis risk.