Psychological distress and risk of long-term disability: population-based longitudinal study

"We take on people's emotions": a qualitative study of physiotherapists' experiences with patients experiencing psychological distress

BACKGROUND

Previous research suggests that physiotherapists frequently engage with patients who experience psychological distress (e.g. feelings of depression and anxiety) and that physiotherapists find supporting these patients challenging.

OBJECTIVE

The aim of this study was to explore the experiences of Australian physiotherapists with patients they perceived were experiencing psychological distress.

METHODS

A 'Big Q' qualitative research approach was used. Twenty-three interviews with physiotherapists were conducted. The data were then analyzed using iterative thematic inquiry.

RESULTS

The analysis produced four interrelated themes: 1) encounters with patients in distress are common and varied; 2) becoming emotionally attuned with their patients meant that distress could invoke empathetic distress; 3) physiotherapists use emotional shields to protect themselves; and 4) physiotherapists found frequent encounters with patient distress to be emotionally exhausting. Viewed together, the themes highlight how patient distress can invoke transient empathetic distress in a physiotherapist; repeated experiences of empathetic distress may lead to empathetic distress fatigue.

CONCLUSION

While physiotherapists are sometimes viewed as 'physical' health professionals, the experiences of these physiotherapists suggest that patient psychological distress is highly relevant to physiotherapy practice. We recommend future research explores the relationships between patient distress, physiotherapists' empathy, and physiotherapists' wellbeing.

Association between psychological distress and disability-free life expectancy in the older Japanese adults

BACKGROUND

Our study aimed to investigate the association between psychological distress and disability-free life expectancy (DFLE).

METHODS

In 2006, a cohort study was conducted of 12,365 Japanese individuals aged ≥65 years, who were followed-up for 13 years. Psychological distress was measured using the Kessler 6-item psychological distress scale and was categorized into no (0-4), mild (5-9), moderate (10-12), and serious distress (13-24). The number of participants was 1277 (22.4 %) for mild distress, 330 (5.8 %) for moderate, and 208 (3.6 %) for serious in men, and was 1635 (24.6 %), 467 (7.0 %), and 384 (5.8 %) in women. Sex-specific DFLE was defined as the mean years a person could expect to live without disability and calculated by Interpolated Markov Chain (IMaCh) software.

RESULTS

Compared to no distress, DFLE loss per person was 1.21, 2.61, and 4.43 years for mild, moderate, and serious distress respectively in men. At population level, DFEL loss (i.e., DFLE loss per person×number of participants) was 1545.17, 861.30, and 921.44 years for mild, moderate, and serious distress respectively in men. Accordingly, 46.4 % of the total DFLE loss was attributable to mild distress, 25.9 % to moderate, and 27.7 % to serious in men. Similarly, the results were 42.2 %, 25.4 %, and 32.4 % in women.

LIMITATIONS

Psychological distress was measured only once at baseline, and 2409 participants were excluded from the analysis because of missing data on exposure.

CONCLUSIONS

At population level, almost half of the total DFLE loss could be attributable to mild distress, underscoring the importance of population strategy for all levels of distress in promoting healthy aging.

Australian physiotherapists' perceived frequency of contact with clients experiencing distress: A cross-sectional survey

BACKGROUND

Previous research suggests physiotherapists' perceived frequency of contact with clients experiencing psychological distress is common; however, there is significant variation in the frequency of such contact.

OBJECTIVE

The study aimed to 1) investigate Australian physiotherapists' perceived frequency of contact with clients experiencing various forms of psychological distress; 2) identify potential factors that predict perceived frequency of contact; and 3) explore physiotherapists' beliefs regarding their role and self-reported capability to identify and assess psychological distress.

METHODS

A nationwide online survey of 340 Australian physiotherapists was conducted, and the data were analyzed using descriptive analysis and regression analysis.

RESULTS

Physiotherapists' perceived frequencies of contact with psychologically distressed and severely distressed clients expressed as proportions of all clients seen each week were 36.1% and 15.6%, respectively. Factors related to the clinical setting were stronger predictors of the perceived frequency of contact (Cohen's f2 = 0.16) than factors related to the physiotherapists themselves (Cohen's f2 = 0.03). Despite believing that identifying psychological distress was within their scope of practice, the physiotherapists in the study felt that assessing and managing this distress fell outside or on the boundary of their scope of practice.

CONCLUSION

Australian physiotherapists frequently encounter clients they perceive to be experiencing psychological distress. Future research into physiotherapists' capability to assess and respond to client psychological distress, using non-self-reported measures, is required.

“From everything to nothing in a split second”: Elite youth players' experiences of release from professional football academies

Previous research has assessed the affects release from football academies has on psychological distress and athletic identity of players. However, there has been no qualitative research exploring players' experiences of the release process. This study retrospectively explored players' lived experiences of being released from a professional football academy, having completed a scholarship (from ages 16–18). Four male football players (age 21.6 ± 1.5 years) who had experienced release from professional academies participated in in-depth semi-structured interviews. Data were analyzed using Interpretative Phenomenological Analysis. Four super-ordinate themes were interpreted from the data: Foreshadowing release—“left out in the cold”, The process of release, Support during the process of release and New beginnings—“there's a bigger world than just playing football every day”. Players reported that their contract meeting was a traumatic experience, and they experienced psychological difficulties in the longer-term following release. Factors that compounded the players' release were: a lack of aftercare being provided by the players' professional clubs for their wellbeing, and a disuse of social support, which hindered their transition out of full-time football. Context relevant recommendations are made to help improve the release process for elite youth football players.

EEG based stress analysis using rhythm specific spectral feature for video game play

BACKGROUND AND OBJECTIVE

For the emerging significance of mental stress, various research directives have been established over time to understand better the causes of stress and how to deal with it. In recent years, the rise of video gameplay has been unprecedented, further triggered by the lockdown imposed due to the COVID-19 pandemic. Several researchers and organizations have contributed to the practical analysis of the impacts of such extended periods of gameplay, which lacks coordinated studies to underline the outcomes and reflect those in future game designing and public awareness about video gameplay. Investigations have mainly focused on the "gameplay stress" based on physical syndromes. Some studies have analyzed the effects of video gameplay with Electroencephalogram (EEG), Magnetic resonance imaging (MRI), etc., without concentrating on the relaxation procedure after video gameplay.

METHODS

This paper presents an end-to-end stress analysis for video gaming stimuli using EEG. The power spectral density (PSD) of the Alpha and Beta bands is computed to calculate the Beta-to-Alpha ratio (BAR). The Alpha and Beta band power is computed, and the Beta-to-Alpha band power ratio (BAR) has been determined. In this article, BAR is used to denote mental stress. Subjects are chosen based on various factors such as gender, gameplay experience, age, and Body mass index (BMI). EEG is recorded using Scan SynAmps2 Express equipment. There are three types of video gameplay: strategic, puzzle, and combinational. Relaxation is accomplished in this study by using music of various pitches. Two types of regression analysis are done to mathematically model stress and relaxation curve. Brain topography is rendered to indicate the stressed and relaxed region of the brain.

RESULTS

In the relaxed state, the subjects have BAR 0.701, which is considered the baseline value. Non-gamer subjects have an average BAR of 2.403 for 1 h of strategic video gameplay, whereas gamers have 2.218 BAR concurrently. After 12 minutes of listening to low-pitch music, gamers achieved 0.709 BAR, which is nearly the baseline value. In comparison to Quartic regression, the 4PL symmetrical sigmoid function performs regression analysis with fewer parameters and computational power.

CONCLUSION

Non-gamers experience more stress than gamers, whereas strategic games stress the human brain more. During gameplay, the beta band in the frontal region is mostly activated. For relaxation, low pitch music is the most useful medium. Residual stress is evident in the frontal lobe when the subjects have listened to high pitch music. Quartic regression and 4PL symmetrical sigmoid function have been employed to find the model parameters of the relaxation curve. Among them, quartic regression performs better in terms of Akaike information criterion (AIC) and R² measure.

The Multi-Sites Trial on the Effects of Therapeutic Gardening on Mental Health and Well-Being

Although many people affected by COVID-19 suffer from some form of psychological distress, access to proper treatment or psychosocial interventions has been limited. This study aimed to examine the feasibility and preliminary effects of a therapeutic gardening program conducted during the COVID-19 pandemic. The program consisted of 30 sessions and was conducted at 10 nationwide sites in Korea from June to November 2021. Mental health and well-being were assessed using the Mental Health Screening Tool for Depressive Disorders, Mental Health Screening Tool for Anxiety Disorders, Engagement in Daily Activity Scale, brief version of World Health Organization Quality of Life, and Mindful Attention Awareness Scale. Cohen’s d value was calculated for the effect size, and a multilevel analysis was used to determine the longitudinal effects of therapeutic gardening. The effect sizes for depression, anxiety, daily activities, quality of life, and mindfulness were 0.84, 0.72, 0.61, 0.64, and 0.40, respectively. Multilevel analyses showed that all five mental health variables improved significantly over time as the therapeutic gardening program progressed. Therapeutic gardening is promising and applicable as a nature-based intervention to improve the mental health of individuals experiencing psychological distress especially in the COVID-19 pandemic.

Employment status, unemployment duration, and health-related metrics among US adults of prime working age: Behavioral Risk Factor Surveillance System, 2018-2019

BACKGROUND

While unemployment has been associated with poor health, few recent studies in the United States have comprehensively assessed associations between employment status (including duration unemployed) and healthcare access, health-related behaviors, and specific health outcomes.

METHODS

We assessed health-related metrics by employment status in 2018-2019 Behavioral Risk Factor Surveillance System respondents ages 25-54. We calculated the unadjusted prevalence and adjusted prevalence ratios to compare employed workers to respondents who were self-employed, short-term (<12 months) unemployed, long-term unemployed, and unable to work.

RESULTS

Adverse health outcomes increased with unemployment duration and were highest for those unable to work. Non-Hispanic Blacks were most likely to be unemployed or unable to work. Short-term unemployment and self-employment were associated with poor healthcare access. Health behaviors and outcomes declined with increasing duration of unemployment and were worst for those unable to work.

CONCLUSIONS

In the United States, access to affordable healthcare is problematic for both the self-employed and the short-term unemployed. Short-term unemployment is a particularly important locus for intervention and provision of resources to prevent health declines that may hinder re-employment.

Non-Preferred Work and the Incidence of Spinal Pain and Psychological Distress-A Prospective Cohort Study

Mental illness and psychological distress are global concerns. This study aimed to investigate the association between having non-preferred work and the incidence of spinal pain, psychological distress, and spinal pain with concurrent psychological distress, and if associations are modified by sleep disturbance. A prospective study of 4285 participants 23-62 years old was conducted, from years 2007 to 2010. Participants reported their work situation as preferred/non-preferred regarding profession/workplace with a high/low possibility to change. Psychological distress was measured with the General Health Questionnaire 12 and spinal pain with questions about neck/back pain. Binominal regression analyses calculated relative risk (RR) with 95% confidence interval (CI). Non-preferred work with a low possibility to change was associated with a higher incidence of spinal pain (RR 1.8; 95% CI 1.2-2.6) and psychological distress (RR 1.8; 95% CI 1.4-2.4) compared to preferred work. The RR was 1.4 (95% CI 0.9-2.1) for spinal pain and 1.3 (95% CI 1.0-1.7) for psychological distress among those with a high possibility to change. Non-preferred work yielded a higher incidence of spinal pain with concurrent psychological distress (RR 1.9; 95% CI 1.0-3.7). Sleep disturbance did not modify associations. A replication based on newer data is needed to confirm the results. In conclusion, non-preferred work is associated with a higher incidence of spinal pain and psychological distress, especially if the possibility to change job is low.

Work ability and psychological distress in a working population: results from the Stockholm Public Health Cohort

AIMS

Psychological distress is a global public health concern with individual and societal implications causing work-related disability and loss of productivity. It is less known how much work ability contributes to the development of psychological distress. This study aimed to assess the association between self-perceived physical and mental work ability in relation to job demands, and the incidence of psychological distress in a Swedish working population.

METHODS

Data were obtained from three subsamples of the Stockholm Public Health Cohort with baseline in 2010 and follow-up in 2014, based on a working population in Stockholm County aged 18-60 years, with no or mild psychological distress at baseline (n=29,882). Self-perceived physical and mental work ability in relation to job demands were assessed at baseline with a subscale from the Work Ability Index. Study participants scoring 4 or more on the General Health Questionnaire 12 at follow-up were classified as having developed psychological distress during the study period. Poisson log linear regression was used to calculate crude and adjusted rate ratios with 95% confidence intervals.

RESULTS

At follow-up, 2543 participants (12%) had developed psychological distress. Reporting poor physical and/or poor mental work ability in relation to job demands at baseline was associated with an almost doubled rate ratio of psychological distress at follow-up, compared to reporting good work ability (rate ratio 1.8; 95% confidence interval 1.6-2.0).

CONCLUSIONS

Poor work ability is associated with a higher incidence of future psychological distress compared to good work ability.

How can dementia and disability be prevented in older adults: where are we today and where are we going?

Ageing of the population, together with population growth, has brought along an ample increase in the number of older individuals living with dementia and disabilities. Dementia is the main cause of disability in old age, and promoting healthy brain ageing is considered as a key element in diminishing the burden of age-related disabilities. The World Health Organization recently launched the first risk reduction guidelines for cognitive impairment and dementia. According to recent estimates, approximately 40% of dementia cases worldwide could be attributable to 12 modifiable risk factors: low education; midlife hypertension and obesity; diabetes, smoking, excessive alcohol use, physical inactivity, depression, low social contact, hearing loss, traumatic brain injury and air pollution indicating clear prevention potential. Dementia and physical disability are closely linked with shared risk factors and possible shared underlying mechanisms supporting the possibility of integrated preventive interventions. FINGER trial was the first large randomized controlled trial indicating that multidomain lifestyle-based intervention can prevent cognitive and functional decline amongst at-risk older adults from the general population. Within the World-Wide FINGERS network, the multidomain FINGER concept is now tested and adapted worldwide proving evidence and tools for effective and easily implementable preventive strategies. Close collaboration between researchers, policymakers and healthcare practitioners, involvement of older adults and utilization of new technologies to support self-management is needed to facilitate the implementation of the research findings. In this scoping review, we present the current scientific evidence in the field of dementia and disability prevention and discuss future directions in the field.

Urgent Need of Integrated Health and Social Care to Alleviate High Psychological Distress in People with Disabilities: A Cross-Sectional National Representative Survey in Australia

OBJECTIVE

To investigate factors in association with high psychological distress in people with disabilities.

METHODS

We used the 2015 national survey on disability in Australia to derive the representative study population of 7936 people with disabilities aged 18+ years. The Kessler Psychological Distress Scale (K10) was used to define high psychological distress (scores ≥22). The explanatory variables included socioeconomic status, physical health, social relationships and environment factors. Adjusted Odds Ratios (ORs) and 95% Confidence Intervals (CIs) were evaluated using weighted Logistic regression models with lasso techniques.

RESULTS

Approximately 21 in 100 study participants experienced high psychological distress. The risk of high psychological distress decreased with age and high educational attainment. Having non-English speaking background (2.31; 1.87-2.85) and need for assistance in cognitive or emotional tasks (3.25; 2.65-3.98) were independently significantly associated with high psychological distress in people with disabilities. Delay seeing a GP was associated with a 2-fold risk increase.

CONCLUSION

Integrated healthcare and social support are warranted with appropriate targeting to improve mental health outcomes in people with disabilities.

Prevalence of exhaustion symptoms and associations with school level, length of work experience and gender: a nationwide cross-sectional study of Swedish principals

BACKGROUND

While poor mental health and psychiatric disorders attributed to stressful work conditions are a public health concern in many countries, the health consequences of the occupational stress experienced by school principals is an understudied issue. Although current data is lacking, some research suggests that principals have a stressful work situation that eventually may lead to burnout and exhaustion disorder, thus negatively affecting the ability of principals to function as leaders. To gauge the situation in Sweden, and as a basis for future preventive actions, we examined to what extent principals displayed signs of exhaustion and whether the prevalence rates of exhaustion differed across school levels, length of work experience as a principal, and gender.

METHODS

Principals (N = 2219; mean age 49 years [SD 7 years]; 78% women) working at least 50% in pre-schools, compulsory schools, upper secondary schools or adult education completed a cross-sectional web survey entailing two validated inventories: The Karolinska Exhaustion Disorder Scale (KEDS) and the Lund University Checklist for Incipient Exhaustion (LUCIE). Data was analysed using traditional non-parametric methods. Gender stratification achieved covariate balance when analysing school level and length of work experience.

RESULTS

Altogether, 29.0% of the principals met the exhaustion criteria in KEDS. The prevalence rates for the four LUCIE-steps of increasing signs of exhaustion were: no signs of stress, 48.8%; weak signs of stress, 25.6%; clear signs of stress but no exhaustion, 15.4%; possible exhaustion disorder, 10.2%. Compared with male principals, female principals reported more signs of possible exhaustion disorder in both LUCIE and KEDS. School level was not associated with reports of exhaustion symptoms in neither LUCIE nor KEDS. Among male principals, length of work experience was associated with exhaustion symptoms in KEDS.

CONCLUSIONS

A large group of Swedish principals working in pre-schools, compulsory schools, upper secondary schools or adult education displayed a symptomatology of signs of exhaustion that if sustained might lead to poor health. This observation suggests that education authorities, or other relevant stakeholders, ought to take some form of preventive action. However, effective combinations of individual, group, organisational, and/or societal preventive activities remain to be identified and tested.

A group memory rehabilitation programme for people with traumatic brain injuries: the ReMemBrIn RCT

BACKGROUND

People with traumatic brain injuries (TBIs) commonly report memory impairments. These are persistent, debilitating and reduce quality of life, but patients do not routinely receive memory rehabilitation after discharge from hospital.

OBJECTIVE

To assess the clinical effectiveness and cost-effectiveness of a group memory rehabilitation programme for people with TBI.

DESIGN

Multicentre, pragmatic, cluster randomised controlled trial. Qualitative and health economic evaluations were also undertaken.

SETTING

Community settings in nine sites in England.

PARTICIPANTS

Participants were aged 18-69 years, had undergone a TBI > 3 months prior to recruitment, reported memory problems, were able to travel to a site to attend group sessions, could communicate in English and gave informed consent.

RANDOMISATION AND BLINDING

Clusters of four to six participants were randomised to the memory rehabilitation arm or the usual-care arm on a 1 : 1 ratio. Randomisation was based on a computer-generated pseudo-random code using random permuted blocks of randomly varying size, stratified by study site. Participants and therapists were aware of the treatment allocation whereas outcome assessors were blinded.

INTERVENTIONS

In the memory rehabilitation arm 10 weekly sessions of a manualised memory rehabilitation programme were provided in addition to usual care. Participants were taught restitution strategies to retrain impaired memory functions and compensation strategies to enable them to cope with memory problems. The usual-care arm received usual care only.

MAIN OUTCOME MEASURES

Outcomes were assessed at 6 and 12 months after randomisation. Primary outcome: patient-completed Everyday Memory Questionnaire - patient version (EMQ-p) at 6 months' follow-up. Secondary outcomes: Rivermead Behavioural Memory Test - third edition (RBMT-3), General Health Questionnaire 30-item version, European Brain Injury Questionnaire, Everyday Memory Questionnaire - relative version and individual goal attainment. Costs (based on a UK NHS and Personal Social Services perspective) were collected using a service use questionnaire, with the EuroQol-5 Dimensions, five-level version, used to derive quality-adjusted life-years (QALYs). A Markov model was developed to explore cost-effectiveness at 5 and 10 years, with a 3.5% discount applied.

RESULTS

We randomised 328 participants (memory rehabilitation, n = 171; usual care, n = 157), with 129 in the memory rehabilitation arm and 122 in the usual-care arm included in the primary analysis. We found no clinically important difference on the EMQ-p between the two arms at 6 months' follow-up (adjusted difference in mean scores -2.1, 95% confidence interval -6.7 to 2.5; p = 0.37). For secondary outcomes, differences favouring the memory rehabilitation arm were observed at 6 months' follow-up for the RBMT-3 and goal attainment, but remained only for goal attainment at 12 months' follow-up. There were no differences between arms in mood or quality of life. The qualitative results suggested positive experiences of participating in the trial and of attending the groups. Participants reported that memory rehabilitation was not routinely accessible in usual care. The primary health economics outcome at 12 months found memory rehabilitation to be £26.89 cheaper than usual care but less effective, with an incremental QALY loss of 0.007. Differences in costs and effects were not statistically significant and non-parametric bootstrapping demonstrated considerable uncertainty in these findings. No safety concerns were raised and no deaths were reported.

LIMITATIONS

As a pragmatic trial, we had broad inclusion criteria and, therefore, there was considerable heterogeneity within the sample. The study was not powered to perform further subgroup analyses. Participants and therapists could not be blinded to treatment allocation.

CONCLUSIONS

The group memory rehabilitation delivered in this trial is very unlikely to lead to clinical benefits or to be a cost-effective treatment for people with TBI in the community. Future studies should examine the selection of participants who may benefit most from memory rehabilitation.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN65792154.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 16. See the NIHR Journals Library website for further project information.

When is work a cause of early retirement and are there any effective organizational measures to combat this? A population-based study of perceived work environment and work-related disorders among employees in Sweden

BACKGROUND

The ageing workforce has an impact on public health. The aim of this study was to evaluate work-related disorders, work tasks and measures associated with the possibility of working beyond 65 years of age or not.

METHOD

The data comprised two sample surveys based on the Swedish population: the Survey of National Work-Related Health Disorders, and the National Work Environment Survey.

RESULTS

A logistic regression analysis showed that an active systematic work environmental management in the workplace was a statistically significant association with whether individuals could work in their current occupation until 65 years of age (OR 1.7). The final multivariate model stated that whether individuals could work until 65 years was associated with bodily exhaustion after work, frequent feeling of the own work effort being insufficient at the end of the day, experience of the work as restricted and with a lack of freedom, working alone and at risk of unsafe or threatening situations, and generally feeling dissatisfied with the work tasks. Women-dominated workplaces were more highly associated with both male and female employees not being able to work until age 65 (OR 1.6).

CONCLUSION

Deficiencies in the working environment seems to be a threat to the public health. An active systematic work environmental management in the workplace increases the possibility to extend the working life. Tools for managers, like the swAge-model, to easily perform active systematic work environmental controls could therefore be a possible way to decrease the risk of work injury as well as increase the possibility for a sustainable extended working life.

The association between sedentary behaviour and indicators of stress: a systematic review

BACKGROUND

Emerging evidence shows sedentary behaviour may be associated with mental health outcomes. Yet, the strength of the evidence linking sedentary behaviour and stress is still unclear. This study aimed to synthesise evidence regarding associations between time spent in sedentary behaviour and stress in adults.

METHODS

A systematic search was conducted (January 1990 - September 2019). Following PRISMA guidelines, an evaluation of methodological quality, and best-evidence synthesis of associations between time in sedentary behaviour (including sitting time, TV viewing, computer use) and stress were presented. Twenty-six studies reporting on data from n = 72,795 people (age 18-98y, 62.7% women) were included.

RESULTS

Across the studies (n = 2 strong-, n = 10 moderate- and n = 14 weak-quality), there was insufficient evidence that overall time spent in sedentary behaviour and sitting time were associated with stress, particularly when using self-report measures of sedentary behaviour or stress. There was strong evidence of no association between TV viewing, or computer use and stress. Amongst studies using objective measures of sedentary behaviour and/or stress there was also strong evidence of no association.

CONCLUSION

Although previous research suggested sedentary behaviour may be linked to mental health outcomes such as depression and anxiety, the evidence for an association between various types of sedentary behaviour and stress is limited in quality, and associations are either inconsistent or null. High-quality longitudinal/interventional research is required to confirm findings and determine the direction of associations between different contexts (i.e. purpose) and domains (i.e. leisure, occupational, transport) of sedentary behaviour and stress.

Common Mental Disorders and Sickness Absence: A Register-Linkage Follow-Up Study Among Finnish Municipal Employees

OBJECTIVE

This study examined how common mental disorders (CMD) at different severity levels are associated with short (1 to 3-day), intermediate (4 to 14-day), and long (15+ day) sickness absence (SA) among Finnish municipal employees.

METHODS

Survey data collected among the 40 to 60-year-old employees of the City of Helsinki in 2000 to 2002 were prospectively linked with employer's SA register data (N = 6554). Associations of CMD (GHQ-12) with SA in a 5-year follow-up were examined with quasi-Poisson regression.

RESULTS

Increasing GHQ-12 scores were associated with a higher number of SA spells. The highest GHQ-12 scores were associated with the highest number of short, intermediate, and long SA spells. Adjusting for social and health-related covariates attenuated the associations but they remained.

CONCLUSION

Increasing severity of CMD increased the risk of short, intermediate, and long SA among Finnish employees. CMD should be tackled to prevent SA and promote work-ability among aging employees.

Predictors of Work Ability in Individuals With a Common Mental Disorder: Is There an Effect of Metacognitive Beliefs Among Poor Physical Health and Emotional Distress?

Work ability is a prospective predictor of sick leave, disability pension and unemployment, and has been defined as the balance between human resources and the demands of work, taking into consideration that illness is not equivalent to work disability. In the present study we set out to explore predictors of work ability in a sample of individuals with common mental disorders. In particular, we were interested in exploring metacognitive beliefs as a potential predictor of work ability, as Wells’ (2009) metacognitive model of psychological disorder suggests that metacognitions may be an underlying factor in psychological vulnerability generally, and they have been associated with work status in previous studies. One hundred and seventy-seven individuals participated in an online survey and completed a battery of self-report questionnaires. Several factors correlated with reduced work ability: physical disorders, emotional distress symptoms and metacognitive beliefs. We found that confidence in memory predicted work ability even when controlling for gender/age, number of physical disorders, and levels of anxiety and depression symptoms. This finding suggest that metacognitions of poor memory performance are associated with low work ability among those with common mental disorders, and implies that these should be targeted in treatment with a view to increasing work ability and thus potentially facilitate return to work.

Using Longitudinal Survey Data to Estimate Mental Health Related Transitions to a Disability Pension: Analysis of an Australian Household Panel Study

OBJECTIVE

This study examined the association between mental ill-health and subsequent receipt of a disability pension in Australia, and assessed how the strength of the association varied in relation to the duration between mental health measurement and reported disability pension receipt.

METHODS

Eight thousand four hundred seventy-four working-age adults not receiving a disability pension at baseline were followed for up to 11 years; 349 transitioned onto a disability pension. Discrete-time survival analysis considered baseline and time-varying (12-month lagged) measures of mental ill-health.

RESULTS

Proximal measures of mental ill-health were more strongly associated with subsequent pension receipt than baseline measures (odds ratio: 6.6 vs 3.9) and accounted for a significantly greater proportion of pension transitions (35% vs 21%).

CONCLUSION

Mental ill-health is an independent risk factor for disability pension receipt, and proximal circumstances better capture this association than mental health measured earlier.

Associations between Urban Green Spaces and Health are Dependent on the Analytical Scale and How Urban Green Spaces are Measured

Although the benefits from exposure to urban green spaces (UGS) are increasingly reported, there are important knowledge gaps in the nature of UGS-health relationships. One such unknown area is the dependence of UGS-health associations on the types of UGS studied, the way they are quantified, and the spatial scale used in the analysis. These knowledge gaps have important ramifications on our ability to develop generalizations to promote implementation and facilitate comparative studies across different socio-cultural and socio-economic contexts. We conducted a study in Singapore to examine the dependence of UGS-health associations on the metrics for quantifying UGS (vegetation cover, canopy cover and park area) in different types of buffer area (circular, nested and network) at different spatial scales. A population-based household survey (n = 1000) was used to collect information on self-reported health and perception and usage pattern of UGS. The results showed that although all three UGS metrics were positively related to mental health at certain scales, overall, canopy cover showed the strongest associations with mental health at most scales. There also appears to be minimum and maximum threshold levels of spatial scale at which UGS and health have significant associations, with the strongest associations consistently shown between 400 m to 1600 m in different buffer types. We discuss the significance of these results for UGS-health studies and applications in UGS planning for improved health of urban dwellers.

Eliminating Individual Bias to Improve Stress Detection from Multimodal Physiological Data

Stress monitoring is important for mental wellbeing and early detection of related disorders. The current work is focused on stress detection from multiple non-invasive physiological signals like Electroencephalogram (EEG), Photoplethysmogram (PPG) and Galvanic Skin Response (GSR). We show that, compared to using only the well known EEG band powers in different frequencies for stress detection, an early fusion with GSR and PPG features shows a significant improvement. Maximum Relevance Minimum Redundancy (mRMR) based feature selection is used to identify the most suitable physiological features correlating with stress. A major contribution of this work lies in eliminating subject-specific bias to improve the classification accuracy. We use self-reported values of Valence, Arousal and Dominance to cluster subjects and build separate classification models specific to clusters. The proposed approach is validated on a publicly available dataset comprising 146 data instances from 10 subjects. The performances of Leave-One- Subject-Out cross validation (LOSOCV) in terms of mean Fscores are 0.61 using EEG features only, 0.64 using early fusion of EEG, GSR and PPG features and 0.69 by applying our clustering technique before fusion and classification.

The Impact of Psychological Distress on Incident Functional Disability in Elderly Japanese: The Ohsaki Cohort 2006 Study

Background: Although psychological distress is known to be a risk factor for death, there are relatively few data on the impact of psychological distress on incident functional disability in older adults. The aim of this study was to examine the impact of psychological distress on incident functional disability in older adults. Methods: We conducted a cohort study of 12,365 disability-free individuals aged ≥65 years who live in Ohsaki City, Japan. In 2006, the level of psychological distress was assessed using the K6 (range: 0⁻24 points). Data on 10-year functional disability were retrieved from the public Long-term Care Insurance database. The multivariate-adjusted hazard ratios (HRs) and population attributable fractions (PAFs) according to the K6 groups (<5, 5⁻9, 10⁻12, and ≥13 points) were estimated. Results: Among 94,636 person-years, incident functional disability occurred in 4533 persons (36.7%). Significantly higher risk was observed in higher K6 score groups. The multiple-adjusted HRs (95% CIs) of incident functional disability were 1.14 (1.06⁻1.22) for 5⁻9 points, 1.28 (1.15⁻1.43) for 10⁻12 points, and 1.62 (1.44⁻1.84) for ≥13 points, in comparison with <5 points (p-trend < 0.001). The PAFs in each of the K6 score groups were 3.0% for 5⁻9 points, 1.7% for 10⁻12 points, and 2.6% for ≥13 points. Conclusions: Even when mild to moderate, psychological distress had a considerable impact on incident functional disability in this cohort.

Serious Psychological Distress and Emergency Room Use among Adults with Multimorbidity in the United States

OBJECTIVES

(1) To examine the association between serious psychological distress (SPD) and emergency room (ER) use in the past 12 months among adults with multimorbidity in the United States (US) and (2) to investigate the association between SPD and the reasons for ER use.

METHODS

The current study used a cross-sectional design with retrospective data from the 2015 National Health Interview Survey. Logistic regression models were used to assess the association between SPD and ER use among adults with multimorbidity. Among ER users, adjusted logistic regression models were conducted to examine the association between SPD and the reasons for the ER use.

RESULTS

After controlling for other variables, adults with multimorbidity and SPD were more likely to use ER than those with multimorbidity and no SPD (AOR = 1.61, 95% CI = 1.26, 2.04). Among ER users, there were no significant associations between SPD and the reasons for ER use after controlling for other variables.

CONCLUSION

Adults with multimorbidity and SPD were more likely to use ER as compared to those with multimorbidity and no SPD. Among adults with multimorbidity, routine screening for SPD may be needed to reduce the ER use.

Potentially traumatic events as predictors of disability pension: A 10-year follow-up study in Norway

AIMS

Are potentially traumatic events associated with subsequent disability pension? Traumatic exposure and post-traumatic stress disorder (PTSD) may represent a disabling state with both personal and professional consequences for the affected individual. Despite this, there is a scarcity of research studying the effects of traumatic exposure on disability pension. This study examined the differences in risk for disability pension among unexposed, exposed to trauma and PTSD cases.

METHODS

An ambidirectional Norwegian cohort study, consisting of 1238 individuals aged 18-66 years who were at risk of disability pension, were interviewed using the Composite International Diagnostic Interview, and linked with registry data on disability pension. Registry follow-up in the Norwegian Insurance Database lasted ten years following interview in 2000-01. The risk of disability pension after traumatic exposure, divided into accidental and premeditated, was assessed by Cox proportional hazards regression analysis.

RESULTS

In 10 years, 9.5% of the cohort had been granted disability pension. Overall exposure to traumatic events did not alter the risk of disability pension. However, among women, exposure to premeditated traumas did increase the risk (HR 2.96 (95% CI 1.54-5.68)), and was an independent risk factor. Fulfilling criteria for PTSD caseness further increased the risk (HR 4.69 (95% CI 1.78-12.40)). There was no increased risk found between traumatic exposure and disability pension for men.

CONCLUSIONS

Exposure to trauma, particularly premeditated trauma, seems to be an independent risk factor for disability pension in women.

Employment status and psychological distress in a population-based cross-sectional study in Sweden: the impact of migration

OBJECTIVES

Unemployment and temporary employment are known to impact psychological health. However, the extent to which the effect is altered by migration-related and sociodemographic determinants is less clear. The purpose of this study was to investigate whether the association between employment status and psychological distress differs between immigrants and Swedish-born and to what extent, the association is modified by gender and reason for immigration.

DESIGN

Cross-sectional survey study.

PARTICIPANTS AND SETTING

Data from public health surveys undertaken in 2002, 2006 and 2010 from random samples of Stockholm County residents, Sweden, were used to analyse a weighted sample of 51 118 individuals aged 18-64 (43 444 Swedish-born, 4055 non-refugees, 3619 refugees). According to their activity in the labour market, the participants were categorised into permanently/self-employed, temporarily employed and unemployed.

OUTCOMES MEASURES

Associations between self-reported employment and psychological distress measured by a 12-item version of the General Health Questionnaire were explored across individuals with different migration status and reasons for immigration using logistic regression and pairwise comparisons. The analyses were stratified by gender and adjusted for age, socioeconomic characteristics and survey year.

RESULTS

Unemployment was associated with elevated likelihood of psychological distress across the study population, regardless of migration status and gender. Fully adjusted models revealed nearly a 3-fold higher odds of distress in unemployed Swedish-born (OR 3.05, 95% CI 2.66 to 3.51), non-refugees (OR 3.51, 95% CI 2.44 to 5.05) and refugees (OR 2.91, 95% CI 2.20 to 3.85) when compared with permanently/self-employed. Temporary employment also increased the likelihood of distress, particularly among refugees and Swedish-born.

CONCLUSIONS

The effect of unemployment on increased likelihood of poor psychological well-being overcomes gender-specific and migration-specific differences and is equally pronounced for Swedish-born, non-refugees and refugees. Exclusion from the labour market appears to be a major determinant of psychological health inequalities in contemporary Sweden.

Effects of psychosocial work factors and psychological distress on self-assessed work ability: A 7-year follow-up in a general working population

BACKGROUND

Toinvestigate the effects of psychosocial work factors (PWF) and psychological distress (PD) on self-assessed work ability.

METHODS

This follow-up study included 7,810 individuals (55%women) with good work ability at baseline. PWFandPD (measured by GHQ-12) were assessed at baseline and work ability at 7-year follow-up. Effects of PWF and PD on work ability were analyzed by logistic regression, odds ratios (OR) with 95% CI, and by mediation analysisusing 4-way decomposition.

RESULTS

Low support was associated with poor work ability for both women and men (OR 1.78 and 1.89). For men, also low skill discretion was associated with poor work ability (OR 2.07). For both women and men, PD was associated with poor work ability (OR 3.41 and 1.84). PD did not act as an intermediate variablein the association between PWF and work ability.

CONCLUSION

Strategies for sustainable work ability should focus on both working conditions and health factors. Am. J. Ind. Med. 60:121-130, 2017. © 2016 Wiley Periodicals, Inc.

Stress Detection Using Wearable Physiological and Sociometric Sensors

Stress remains a significant social problem for individuals in modern societies. This paper presents a machine learning approach for the automatic detection of stress of people in a social situation by combining two sensor systems that capture physiological and social responses. We compare the performance using different classifiers including support vector machine, AdaBoost, and [Formula: see text]-nearest neighbor. Our experimental results show that by combining the measurements from both sensor systems, we could accurately discriminate between stressful and neutral situations during a controlled Trier social stress test (TSST). Moreover, this paper assesses the discriminative ability of each sensor modality individually and considers their suitability for real-time stress detection. Finally, we present an study of the most discriminative features for stress detection.

The Lund University Checklist for Incipient Exhaustion: a prospective validation of the onset of sustained stress and exhaustion warnings

Background

The need for instruments that can assist in detecting the prodromal stages of stress-related exhaustion has been acknowledged. The aim of the present study was to evaluate whether the Lund University Checklist for Incipient Exhaustion (LUCIE) could accurately and prospectively detect the onset of incipient exhaustion and to what extent work stressor exposure and private burdens were associated with increasing LUCIE scores.

Methods

Using surveys, 1355 employees were followed for 11 quarters. Participants with prospectively elevated LUCIE scores were targeted by three algorithms entailing 4 quarters: (1) abrupt onset to a sustained Stress Warning (n = 18), (2) gradual onset to a sustained Stress Warning (n = 42), and (3) sustained Exhaustion Warning (n = 36). The targeted participants’ survey reports on changes in work situation and private life during the fulfillment of any algorithm criteria were analyzed, together with the interview data. Participants untargeted by the algorithms constituted a control group (n = 745).

Results

Eighty-seven percent of participants fulfilling any LUCIE algorithm criteria (LUCIE indication cases) rated a negative change in their work situation during the 4 quarters, compared to 48 % of controls. Ratings of negative changes in private life were also more common in the LUCIE indication groups than among controls (58 % vs. 29 %), but free-text commentaries revealed that almost half of the ratings in the LUCIE indication groups were due to work-to-family conflicts and health problems caused by excessive workload, assigned more properly to work-related negative changes. When excluding the themes related to work-stress-related private life compromises, negative private life changes in the LUCIE indication groups dropped from 58 to 32 %, while only a negligible drop from 29 to 26 % was observed among controls. In retrospective interviews, 79 % of the LUCIE indication participants confirmed exclusively/predominantly work stressors, while 6 % described a predominance of private life stressors.

Conclusions

Negative changes in the work situation were the most prominent change related to a sustained increase in LUCIE scores. The findings seem to confirm that LUCIE is a potentially useful tool for clinical screening of incipient work-related exhaustion.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3720-7) contains supplementary material, which is available to authorized users.

Cannabis use and psychological distress: An 8-year prospective population-based study among Swedish men and women

BACKGROUND

Previous studies have reported positive associations between cannabis use and mental health problems. However, it has not been possible to draw a definitive conclusion regarding the causal direction between cannabis use and impaired mental health. This study aimed at examining possible associations between cannabis use and psychological distress (as measured by the General Health Questionnaire, GHQ-12) in men and women respectively, using both measures as both exposure and outcome.

METHODS

Data were obtained from a cohort study (the Stockholm Public Health Cohort) with an 8-year follow-up in the general population in Stockholm County, Sweden. The study sample comprised 19,327 men and women, aged 18-84years, who answered surveys in 2002 and 2010.

RESULTS

Cannabis use was associated with increased odds ratios (OR) for psychological distress in women at 8-year follow-up, with OR=1.37 [1.1-1.7, 95% CI], but not in men; OR=1.14 [0.9-1.5, 95% CI]. In women, this association remained when adjusted for potential confounders (tobacco smoking, alcohol consumption, socioeconomic position (SEP) and unemployment); OR=1.27 [1.0-1.6, 95% CI]. Moreover, women reporting psychological distress at baseline had an increased risk of cannabis use at follow-up; OR=1.40 [1.1-1.8 95% CI]. However, this association was no longer statistically significant when adjustments were made for baseline cannabis use, OR=1.10 [0.8-1.5, 95% CI].

CONCLUSIONS

This study revealed that, in women, cannabis use was associated with an increased risk of psychological distress eight years later. Optimal interventions to identify these women seem warranted.

Long-term physical workload in middle age and disability pension in men and women: a follow-up study of Swedish cohorts

Purpose

The study investigates the association between level of long-term physical workload in middle age and disability pension (DP) before 61 years of age with adjustments made for early life factors, level of education, and psychosocial working conditions. Associations with DP overall, DP due to musculoskeletal disorders and DP due to psychiatric disorders were examined.

Methods

The study is based on cohorts of 21,809 Swedish men and women born in 1948 and 1953, with data on physical workload estimated with a job exposure matrix based on occupational titles in 1985 and 1990 and follow-up data on diagnosis-specific DP in the years 1991–2009. Data on paternal education and intelligence were collected in primary school. Data on level of education were taken from administrative records. Data on psychosocial working conditions were estimated with a job exposure matrix based on occupational titles in 1990.

Results

Long-term exposure to high physical workload measured 5 years apart at around age 40 was strongly associated with DP due to musculoskeletal disorders up to the age of 61 among both men (HR 5.44, 95 % CI 3.35–8.84) and women (HR 3.82, CI 95 % 2.88–5.08). For women, the association between high physical load and overall DP was also significantly increased (HR 2.33, CI 95 % 1.92–2.82). The increased risks remained but were clearly attenuated after adjustments for fathers’ education, IQ in childhood, achieved education and level of control at work.

Conclusions

Exposure to high physical workload is associated with long-term risk of DP due to musculoskeletal disorders, even though adjustments for early life factors, level of education and psychosocial working conditions clearly attenuated the risks.

The Lund University Checklist for Incipient Exhaustion-a cross-sectional comparison of a new instrument with similar contemporary tools

Background

Stress-related health problems (e.g., work-related exhaustion) are a societal concern in many postindustrial countries. Experience suggests that early detection and intervention are crucial in preventing long-term negative consequences. In the present study, we benchmark a new tool for early identification of work-related exhaustion–the Lund University Checklist for Incipient Exhaustion (LUCIE)–against other contextually relevant inventories and two contemporary Swedish screening scales.

Methods

A cross-sectional population sample (n = 1355) completed: LUCIE, Karolinska Exhaustion Disorder Scale (KEDS), Self-reported Exhaustion Disorder Scale (s-ED), Shirom-Melamed Burnout Questionnaire (SMBQ), Utrecht Work Engagement Scale (UWES-9), Job Content Questionnaire (JCQ), Big Five Inventory (BFI), and items concerning work-family interference and stress in private life.

Results

Increasing signs of exhaustion on LUCIE were positively associated with signs of exhaustion on KEDS and s-ED. The prevalence rates were 13.4, 13.8 and 7.8 %, respectively (3.8 % were identified by all three instruments). Increasing signs of exhaustion on LUCIE were also positively associated with reports of burnout, job demands, stress in private life, family-to-work interference and neuroticism as well as negatively associated with reports of job control, job support and work engagement.

Conclusions

LUCIE, which is intended to detect pre-stages of ED, exhibits logical and coherent positive relations with KEDS and s-ED as well as other conceptually similar inventories. The results suggest that LUCIE has the potential to detect mild states of exhaustion (possibly representing pre-stages to ED) that if not brought to the attention of the healthcare system and treated, may develop in to ED. The prospective validity remains to be evaluated.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3001-5) contains supplementary material, which is available to authorized users.

Loneliness and depressive symptoms among older adults: The moderating role of subjective life expectancy

Loneliness and depressive symptoms are closely related, and both are indicators of reduced physical and mental well-being in old age. In recent years, the subjective perception of how long an individual expects to live (subjective life expectancy) has gained importance as a significant predictor of future psychological functioning, as well as of physical health. The current study examined whether subjective life expectancy moderates the connection between loneliness and depressive symptoms in a representative sample of older adults. Data was collected from the Israeli component of the fifth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE-Israel). Participants (n=2210; mean age=70.35) completed measures of loneliness, depressive symptoms, and life expectancy target age. A hierarchical regression analysis predicting depressive symptoms yielded a significant interaction of loneliness and subjective life expectancy. Further analyses demonstrated that low subjective life expectancy mitigated the loneliness-depressive symptoms connection. Findings are discussed in light of the potential burden of higher subjective life expectancy for lonesome older adults, and practical implications are suggested.

Predicting disability pension - depression as hazard: a 10 year population-based cohort study in Norway

Disability pension (DP) is an escalating challenge to individuals and the welfare state, with mental health problems as imminent hazard. The objective of the present paper was to determine if a diagnosis of depression increased the risk of subsequent DP, and whether the risk differed by gender. A population cohort of 1230 persons were diagnostically interviewed (Composite International Diagnostic Interview, CIDI) in a population study examining mental health, linked to the DP registry and followed for 10 years. The risk for DP following depression was estimated using Cox regression. Life-time depression, as well as current depression, increased the risk of subsequent DP for both genders. The fully adjusted [baseline health, health behavior and socio-economic status (SES)] hazard ratios (HRs) for life-time depressed men and women were 2.9 [95% confidence interval (CI) 1.5-5.8] and 1.6 (95% CI 1.0-2.5) respectively. Men were significantly older at time of DP. There are reasons to believe that depression went under-recognized and under-treated. To augment knowledge in the field, without underestimating depression as risk for DP, a deeper understanding of the nature and effects of other distress is needed.

[The primary screening of patients with autonomic disorders in outpatient clinics in Russia (START1) using the Russian version of The Four-Dimensional Symptom Questionnaire (4DSQ)]

OBJECTIVE

To develop an effective diagnostic algorithm for detection of a mental component in the state of patients diagnosed with autonomic nervous system disorder.

MATERIAL AND METHODS

In the frames of START1 epidemiological study, we examined 6633 patients with autonomic nervous system disorders (ICD-10 G.90.8 and G90.9) and somatoform disorders (F45) including 18,8% patients who got a referral to a psychiatrist. A linguistically validated Russian version of The Dutch Four-Dimensional Symptoms Questionnaire (4DSQ) was tested in domain subpopulations.

RESULTS

In subpopulations of anxiety and depression, more than 26% of the patients got a referral to a psychiatrist that indirectly supported the assumption on the conformity of 4DSQ to the purposes of primary screening of four-dimensional disorders in the general population of patients with autonomic nervous system disorders.

CONCLUSION

The linguistically validated Russian version of 4DSQ enabled to formalize the description of clinical profile of these patients. Cluster analysis of the results allowed to single out two superdomains by the pairwise combination somatization with distress (SDis) and anxiety with depression (ADep). The detection of superdomain SDis appears to be a population specific characteristic of autonomic nervous system disorders in the Russian Federation.

A prospective study on self-assessed mental well-being and work capacity as determinants of all-cause sickness absence

PURPOSE

The aim of the present study was to estimate whether self-assessed mental well-being and work capacity determines future sickness absence (SA).

METHODS

A questionnaire was sent to employed individuals (n = 6,140), aged 19-64 years, who were registered as sick-listed with a new sick-leave spell in 2008. The response rate was 54 %. In this study we included individuals with a single sick-leave spell in 2008 (n = 2,502). The WHO (Ten) Well-Being Index and four dimensions of self-assessed work capacity (knowledge, mental, collaborative, physical) were used as determinants. Future sickness absence was identified through national register in 2009. Outcome was defined as no sickness benefit compensated days (no SBCD) and at least one sickness benefit compensated day (SBCD). Logistic regression analyses were used to estimate odds ratios (OR) with 95 % confidence intervals (CI) for the likelihood of SBCD.

RESULTS

In 2009, 28 % of the women and 22 % of the men had SBCD; the median was 59 and 66 benefit days, respectively. Individuals with low mental well-being had higher odds for SBCD with OR 1.29 (95 % CI 1.01-1.65) in the fully adjusted model. Participants reporting low work capacity in relation to knowledge (OR 1.55, 95 % CI 1.13-2.13), collaborative (OR 1.36, 95 % CI 1.03-1.79) and physical (OR 1.50, 95 % CI 1.22-1.86) demands at work had higher odds for SBCD after adjustments for all covariates; no relation was demonstrated with mental work capacity (OR 0.99, 95 % CI 0.76-1.27).

CONCLUSION

Mental well-being and work capacity emerged as determinants of future SA. Screening in health care could facilitate early identification of persons in need of interventions to prevent future SA.

Natural environments, ancestral diets, and microbial ecology: is there a modern "paleo-deficit disorder"? Part I

Famed microbiologist René J. Dubos (1901-1982) was an early pioneer in the developmental origins of health and disease (DOHaD) construct. In the 1960s, he conducted groundbreaking experimental research concerning the ways in which early-life experience with nutrition, microbiota, stress, and other environmental variables could influence later-life health outcomes. He also wrote extensively on potential health consequences of a progressive loss of contact with natural environments (now referred to as green or blue space), arguing that Paleolithic experiences have created needs, particularly in the mental realm, that might not be met in the context of rapid global urbanization. He posited that humans would certainly adapt to modern urban landscapes and high technology, but there might be a toll to be paid in the form of higher psychological distress (symptoms of anxiety and depression) and diminished quality of life. In particular, there might be an erosion of humanness, exemplified by declines in altruism/empathy. Here in the first of a two-part review, we examine contemporary research related to natural environments and question to what extent Dubos might have been correct in some of his 50-year-old assertions.

Common mental disorders and cause-specific disability retirement

OBJECTIVES

Common mental disorders are prevalent among employees and may cause work disability. We aimed to examine the association between common mental disorders and disability retirement, with an emphasis on the severity of disorders and diagnostic causes for retirement.

METHODS

Our data were derived from the Helsinki Health Study cohort on the staff of the City of Helsinki, Finland. The baseline mail surveys were made in 2000-2002 among employees reaching ages 40, 45, 50, 55 and 60 in each year (n=8960, response rate 67%, 80% women). Disability retirement events from national registers (n=628) were followed up by the end of 2010 and linked to the baseline data. After exclusions, the number of participants was 6525. Common mental disorders were measured by the General Health Questionnaire 12-item version (GHQ-12). Covariates at baseline included sociodemographic, work-related and health-related factors. Hazard ratios (HR) and 95% CIs were calculated using Cox proportional hazards models.

RESULTS

Common mental disorders showed a graded association with disability retirement. For disability retirement due to any diagnostic cause, the fully adjusted HR for the GHQ-12 score 7-12 was 2.16, 95% CI 1.63 to 2.85. For disability retirement due to mental disorders the corresponding HR was 7.46, 95% CI 4.46 to 12.49. For disability retirement due to musculoskeletal diseases, the association was weaker and did not survive all adjustments.

CONCLUSIONS

Common mental disorders are an important antecedent of disability retirement in general and due to mental disorders in particular. Successful measures against common mental disorders may prevent disability retirement due to mental disorders.

Cannabis use in adolescence and risk of future disability pension: a 39-year longitudinal cohort study

AIMS

This study aimed at examining a possible association between cannabis use in adolescence and future disability pension (DP). DP can be granted to any person in Sweden aged 16-65 years if working capacity is judged to be permanently reduced due to long-standing illness or injury.

METHODS

Data were obtained from a longitudinal cohort study comprising 49,321 Swedish men born in 1949-1951 who were conscripted to compulsory military service aged 18-20 years. Data on DP was collected from national registers.

RESULTS

Results showed that individuals who used cannabis in adolescence had considerably higher rates of disability pension throughout the follow-up until 59 years of age. In Cox proportional-hazards regression analyses, adjustment for covariates (social background, mental health, physical fitness, risky alcohol use, tobacco smoking and illicit drug use) attenuated the associations. However, when all covariates where entered simultaneously, about a 30% increased hazard ratio of DP from 40 to 59 years of age still remained in the group reporting cannabis use more than 50 times.

CONCLUSIONS

This study shows that heavy cannabis use in late adolescence was associated with an increased relative risk of labor market exclusion through disability pension.

The sex-specific interrelationship between spinal pain and psychological distress across time in the general population. Results from the Stockholm Public Health Study

BACKGROUND CONTEXT

Detailed knowledge about the interrelationship between neck pain, back pain, and psychological distress is important from a public health prospective, but missing because of lack of large population-based cohort studies.

PURPOSE

To assess and compare the sex-specific recovery rate of spinal pain and psychological distress as single and comorbid conditions, to describe the interrelationship between these conditions at the baseline (2002) and follow-up 5 years later, and to explore the questions of spinal pain as a risk factor for the onset of psychological distress and vice versa.

STUDY DESIGN

A prospective cohort study.

PATIENT SAMPLE

General population in Stockholm county aged 18 to 84 years, n=19,774.

OUTCOME MEASURES

Spinal pain (modified Nordic Pain Questionnaire) and psychological distress (General Health Questionnaire-12).

METHODS

A random sample of the population in Stockholm was approached with postal questionnaires at the baseline and at follow-up.

RESULTS

Comorbidity of spinal pain and distress was twice as common among women (11%) than among men (4%) (relative risk=2.4, 95% confidence interval [CI]: 2.1-2.7). Women also more commonly had spinal pain without psychological distress (women, 20%; men, 14%) and vice versa (women, 15%; men, 12%). Comorbidity makes recovery less probable (women, 26%; men, 27%) than having single conditions of spinal pain (women, 41%; men, 44%) or psychological distress (women, 49%; men, 52%). No statistical significant sex differences were seen. Twenty-four percent of the women and 17% of the men with spinal pain without psychological distress at the baseline had psychological distress at follow-up. Corresponding figures for spinal pain among participants with psychological distress without spinal pain at the baseline were 24% and 20%. Spinal pain was a determinant of psychological distress (odds ratio [OR]=2.6, 95% CI: 2.3-2.9) and vice versa (OR=2.0, 95% CI: 1.8-2.2).

CONCLUSIONS

Spinal pain and psychological distress as comorbid and single conditions are common in the general population, especially among women. Comorbidity affects recovery negatively both in men and women. This study confirms the bidirectional association between spinal pain and psychological distress in the general population.

Effect of neighbourhood deprivation and social cohesion on mental health inequality: a multilevel population-based longitudinal study

BACKGROUND

The common mental disorders (CMDs) of anxiety and depression are the most common form of poor mental health in the general population. Evidence from the small number of previous cohort studies on the role of neighbourhood factors in mental health is inconclusive. We tested the hypothesis that high levels of neighbourhood social cohesion modify an adverse association between change in individual mental health and neighbourhood deprivation.

METHOD

We carried out a longitudinal multilevel analysis using data from the Caerphilly Health and Social Needs Cohort Study with a 7-year follow-up (n = 4426; age range 18-74 years at baseline). Neighbourhood deprivation and neighbourhood social cohesion were assessed at baseline and change in mental health between follow-up and baseline was assessed using the five-item Mental Health Inventory (MHI-5).

RESULTS

Residence in the most deprived neighbourhoods was negatively associated with change in mental health, after adjusting for baseline individual socio-economic risk factors and transitions in life events. This negative effect was significantly reduced in high social cohesion neighbourhoods. The predicted change in mental health score was calculated for the 10th and 90th centiles of the household low-income distribution. The difference between them was -2.8 in the low social cohesion group and 1.1 in the high cohesion group. The difference between the groups was 3.9 [95% confidence interval (CI) 0.2-7.6].

CONCLUSIONS

The public health burden of poor mental health and mental health inequality could potentially be reduced by strengthening social cohesion in deprived neighbourhoods. This offers a mechanism to address the adverse effect of neighbourhood deprivation on population mental health.

Social integration, socioeconomic conditions and type of ill health preceding disability pension in young women: a Swedish population-based study

BACKGROUND

Disability pension has increased in recent decades and is seen as a public health and socioeconomic problem in Western Europe. In the Nordic countries, the increase has been particularly steep among young women.

PURPOSE

The aim was to analyze the influence of low social integration, socioeconomic risk conditions and different measures of self-reported ill health on the risk of receiving disability pension in young women.

METHOD

The study comprised all Swedish women born in 1960 to 1979, who had been interviewed in any of the annual Swedish Surveys of Living Conditions (1990-2002). The assumed predictors were related to disability pension by Cox proportional hazard regression. The mean number of years of follow-up for the 10,936 women was 7 years (SD 3.8), and the study base was restricted to the ages 16 to 43 years of age.

RESULTS

An increased risk of receiving a disability pension was found among lone women, those who had sparse contacts with others, job-seeking women, homemakers, as well as women with low education, and poor private financial situations. A tenfold increase in the risk of receiving a disability pension was found among women reporting a long-standing illness and poor self-rated health, compared to women without a long-standing illness and good self-rated health. Psychiatric diagnoses and symptoms/unspecified illness were the strongest predictors of disability pension, particularly before 30 years of age.

CONCLUSION

The study suggests that weak social relations and weak connections to working life contribute to increase the risk of disability pension in young women, also after control for socioeconomic conditions and self-reported ill health. Self-rated health was the strongest predictor, followed by long-standing illness and not having a job (job seekers and homemakers).

Psychological distress and emergency department utilization in the United States: evidence from the Medical Expenditure Panel Survey

OBJECTIVES

Psychological distress not only has substantial health and social consequences, but is also associated with emergency department (ED) use. Previous studies have typically used cross-sectional data to focus on the relation between serious psychological distress and dichotomized ED utilization measures, without assessing the volume of ED use or examining nonserious levels of psychological distress. The objective of this study was to explore the association between ED utilization volume and the full spectrum of psychological distress.

METHODS

Data from Panel 14 of the Medical Expenditure Panel Survey (MEPS; 2009-2010, n = 9,743) provided a nationally representative sample of U.S. individuals. ED utilization volume and three specifications of the Kessler Psychological Distress Scale (K6) were analyzed: a dichotomous serious/no serious psychological distress measure, a five-category ordinal measure, and a scale measure with a range of 0 to 24. Negative binomial-logit hurdle regression models were used to analyze how the different specifications of the K6 psychological distress measure were related to ED use.

RESULTS

Adults with serious psychological distress in 2009 had 1.59 (95% confidence interval [CI] = 1.15 to 2.20) times greater adjusted odds of having one or more ED visits in 2010 than those without serious psychological distress. Nonserious psychological distress levels in 2009 were also associated with increased adjusted odds of having at least one ED visit in 2010. The K6 scores showed a dose-response relationship in terms of the adjusted odds of having one or more ED visits. The adjusted odds ratios (ORs) were 1.86 (95% CI = 1.37 to 2.54) for adults with K6 scores at or above 11, OR 1.76 (95% CI = 1.38 to 2.25) for adults with K6 scores between 6 and 10, OR 1.33 (95% CI = 1.05 to 1.68) for adults with K6 scores between 3 and 5, and OR 1.17 (95% CI = 0.92 to 1.48) for adults with K6 scores of 1 or 2. In addition, the adjusted odds of having one or more ED visits in 2010 significantly increased with increasing psychological distress in 2009 (OR = 1.04, 95% CI = 1.03 to 1.06). Each additional point added to the K6 scale results in an increase in the adjusted odds of an ED visit.

CONCLUSIONS

Even a low level of psychological distress, and not just serious psychological distress, may be an early indicator of future ED use. These results highlight the need to develop novel responses to better manage or avert ED use not only for adults with serious psychological distress but also for those who are experiencing even mild symptoms of psychological distress.

Severity of psychological distress among adults with and without disabilities

The aim of this study is to examine psychological distress and its individual symptoms between adults with and without disabilities, and among adults with disabilities, to examine whether an association exists between severity of distress and health-related factors. Cross-sectional data from the 2007 Behavioral Risk Factor Surveillance System were used for this study. Severity of psychological distress was assessed using the Kessler 6 scale of nonspecific psychological distress. Logistic regression analyses were performed to estimate predicted marginals and prevalence ratios. Nine percent of adults had mild to moderate psychological distress and 3.9% had serious psychological distress. The adjusted mean Kessler 6 total scores and individual item scores were higher for adults with disabilities, as was the average number of days that a mental health condition interfered with activities in the past 30 days. Among adults with disabilities, mild to moderate and serious psychological distress were particularly high among those who were unemployed or unable to work. Those who had either mild to moderate or serious psychological distress were significantly more likely than those with no psychological distress to be physically inactive, to smoke, and to report fair or poor health, life dissatisfaction, and inadequate social support. A dose-response relationship exists between categorical severity of psychological distress and examined health-related factors. These findings may inform the design of targeted public health strategies that aim to eliminate health disparities between people with and without disabilities.

Effects of an integrative treatment, therapeutic acupuncture and conventional treatment in alleviating psychological distress in primary care patients--a pragmatic randomized controlled trial

BACKGROUND

To evaluate and compare effects of an integrative treatment (IT), therapeutic acupuncture (TA), and conventional treatment (CT) in alleviating symptoms of anxiety and depression in psychologically distressed primary care patients.

METHODS

An open, pragmatic randomized controlled trial comparing the three treatment regimens at four and eight weeks after treatment. The study sample consisted of 120 adults (40 per treatment arm) aged 20 to 55 years referred from four different primary health care centres in western Sweden for psychological distress. Psychological distress was evaluated at baseline, and after 4 and 8 weeks of treatment using the Hospital Anxiety and Depression scale (HAD). Treatment sessions lasted about 60 minutes in IT and 45 minutes in TA.

RESULTS

No baseline differences were found between groups on HAD depression or anxiety. HAD anxiety and depression decreased significantly more in the IT and TA groups than in the CT group both after 4 and 8 weeks of treatment, but not between IT and TA. Improvements in the TA and IT groups were large and clinically significant, whereas CT effects were small and clinically non-significant.

CONCLUSIONS

Both IT and TA appear to be beneficial in reducing anxiety and depression in primary care patients referred for psychological distress, whereas CT does not. These results need to be confirmed in larger, longer-term studies addressing potentially confounding design issues in the present study.

TRIAL REGISTRATION

ISRCTN trial number NCT01631500.

Does social isolation and low societal participation predict disability pension? A population based study

Purpose

The aim was to examine the potential influence of social isolation and low societal participation on the future risk of receiving disability pension among individuals in Sweden. A specific aim was to describe differences depending on disability pension diagnoses, and how the results were modified by sex and age.

Method

The study comprised representative samples of Swedish women and men, who had been interviewed in any of the annual Swedish Surveys of Living Conditions between 1990 and 2007. Information on disability pension and diagnoses was added from the Swedish Social Insurance Agency’s database (1991-2011). The mean number of years of follow-up for the 53920 women and men was twelve years (SD 5.5), and the study base was restricted to the ages 20 to 64 years of age. The predictors were related to disability pension by Cox’s proportional hazards regression.

Results

Social isolation and low societal participation were associated with future disability pension also after control for age, year of interview, socio demographic conditions and self reported longstanding illness. Lone individuals were at increased risk of disability pension, and the effect of living without children was modified by sex and age. An increase in risk was particularly noticeable among younger women who reported that they had sparse contacts with others, and no close friend. Both women and men who reported that they did not participate in political discussions and who could not appeal on a decision by a public authority were also at increased risk. The effects of social isolation were mainly attributed to disability pension with mental diagnoses, and to younger individuals.

Conclusions

The study suggests that social isolation and low societal participation are predictors of future disability pension. Social isolation and low societal participation increased particularly the risk of future disability pension in mental diagnoses among younger individuals.

Influence of poor health on exit from paid employment: a systematic review

The objective was to provide a systematic literature review on associations between poor health and exit from paid employment through disability pension, unemployment and early retirement, and to estimate the magnitude of these associations using meta-analyses. Medline and Embase databases were searched for longitudinal studies on the relationship between health measures and exit from paid employment. Random-effects models were used to estimate the pooled effects. In total, 29 studies were included. Self-perceived poor health was a risk factor for transition into disability pension (relative risk (RR) 3.61; 95% CI 2.44 to 5.35), unemployment (RR 1.44; 95% CI 1.26 to 1.65) and early retirement (RR 1.27; 95% CI 1.17 to 1.38). Workers with mental health problems had an increased likelihood for transition into disability pension (RR 1.80; 95% CI 1.41 to 2.31) or unemployment (RR 1.61; 95% CI 1.29 to 2.01). Chronic disease was a risk factor for transition into disability pension (RR 2.11; 95% CI 1.90 to 2.33) or unemployment (RR 1.31; 95% CI 1.14 to 1.50), but not for early retirement. This meta-analysis showed that poor health, particularly self-perceived health, is a risk factor for exit from paid employment through disability pension, unemployment and, to a lesser extent, early retirement. To increase sustained employability it should be considered to implement workplace interventions that promote good health.

Self-assessed mental health problems and work capacity as determinants of return to work: a prospective general population-based study of individuals with all-cause sickness absence

BACKGROUND

Mental health problems are common in the work force and influence work capacity and sickness absence. The aim was to examine self-assessed mental health problems and work capacity as determinants of time until return to work (RTW).

METHODS

Employed women and men (n=6140), aged 19-64 years, registered as sick with all-cause sickness absence between February 18 and April 15, 2008 received a self-administered questionnaire covering health and work situation (response rate 54%). Demographic data was collected from official registers. This follow-up study included 2502 individuals. Of these, 1082 were currently off sick when answering the questionnaire. Register data on total number of benefit compensated sick-leave days in the end of 2008 were used to determine the time until RTW. Self-reported persistent mental illness, the WHO (Ten) Mental Well-Being Index and self-assessed work capacity in relation to knowledge, mental, collaborative and physical demands at work were used as determinants. Multinomial and binary logistic regression analyses were used to estimate odds ratios with 95% confidence intervals (CI) for the likelihood of RTW.

RESULTS

The likelihood of RTW (≥ 105 days) was higher among those with persistent mental illness OR= 2.97 (95% CI, 2.10-4.20) and those with low mental well-being OR= 2.89 (95% CI, 2.31-3.62) after adjusting for gender, age, SES, hours worked and sick leave 2007. An analysis of employees who were off sick when they answered the questionnaire, the likelihood of RTW (≥ 105 days) was higher among those who reported low capacity to work in relation to knowledge, mental, collaborative and physical demands at work. In a multivariable analysis, the likelihood of RTW (≥ 105 days) among those with low mental well-being remained significant OR=1.93 (95% CI 1.46-2.55) even after adjustment for all dimensions of capacity to work.

CONCLUSION

Self-assessed persistent mental illness, low mental well-being and low work capacity increased the likelihood of prolonged RTW. This study is unique because it is based on new sick-leave spells and is the first to show that low mental well-being was a strong determinant of RTW even after adjustment for work capacity. Our findings support the importance of identifying individuals with low mental well-being as a way to promote RTW.

The health benefits of network growth: new evidence from a national survey of older adults

Scholars who study how social networks affect older adults' health are often concerned with the prospect of declining social connectedness in late life. This paper shifts the focus to older adults' tendencies to cultivate new social ties. This process of network growth can improve access to social resources, boost self-esteem, reduce loneliness, and increase physical activity. We therefore examine the link between tie cultivation and health using new longitudinal data from the National Social Life, Health, and Aging Project (NSHAP), which recorded changes in older adults' confidant network rosters over a period of about five years. Most respondents (81.8%) added at least one new network member during the study period, and most (59.4%) cultivated multiple new confidant relationships. Longitudinal analyses suggest that the addition of new confidants is associated with improvements in functional, self-rated, and psychological health, net of baseline connectedness as well as any network losses that occurred during the same period. Network losses were associated with physical but not psychological well-being. These findings underscore the importance of distinguishing between concurrent processes that underlie social network change in later life, and highlight the need for additional research on the mechanisms by which network change may improve health.