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Nouraeinejad A. Visuospatial processing can be disrupted in healthcare workers during the COVID-19 pandemic. Int J Neurosci 2024:1-3. [PMID: 38289179 DOI: 10.1080/00207454.2024.2312995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 01/27/2024] [Indexed: 02/10/2024]
Affiliation(s)
- Ali Nouraeinejad
- Faculty of Brain Sciences, Institute of Ophthalmology, University College London (UCL), London, United Kingdom
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Pihlaja M, Peräkylä J, Erkkilä EH, Tapio E, Vertanen M, Hartikainen KM. Altered neural processes underlying executive function in occupational burnout-Basis for a novel EEG biomarker. Front Hum Neurosci 2023; 17:1194714. [PMID: 37850039 PMCID: PMC10577205 DOI: 10.3389/fnhum.2023.1194714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/22/2023] [Indexed: 10/19/2023] Open
Abstract
Introduction As burnout has become a global pandemic, there is a call for improved understanding and detection of alterations in brain functions related to it. We have previously reported challenges in executive functions (EFs) in daily life, especially in metacognition, in subjects with occupational burnout, along with alterations in cardiac physiology. In the current study, we focused on the impact of burnout on brain physiology during a task requiring EF. Methods Fifty-four volunteers filled in inventories of burnout, depression, and EF in daily life (BBI-15, BDI, and BRIEF-A). Based on the BBI-15 score, subjects were divided into burnout and non-burnout groups. Subjects performed a Go/NoGo test (Executive RT test) engaging several EFs, while their EEG was recorded. The inventory scores, cognitive performance scores, and event-related potential (N2, P3) amplitudes, latencies, and interpeak latencies (IPLs) were compared between the groups. Results There were significant differences in the BDI and BRIEF-A scores between the groups, with more symptoms of depression and challenges in daily life in the burnout group. There were no differences in objective performance measures in the EF task between the groups. However, centroparietal P3 amplitude was larger, and while there were no differences in N2 or P3 latencies, N2-P3 IPL was longer in the Go condition in the burnout than in non-burnout group. Both ERP measures correlated significantly with burnout symptoms. A regression model from centroparietal P3 amplitude and N2-P3 IPL predicted significantly both the BBI-15 score and the BRIEF-A metacognition index. Discussion We conclude that burnout is linked with challenges in EF in daily life and alterations in the underlying neural processes. While cognitive performance in the task was equal, electrophysiological measures differed between the groups. Prolonged N2-P3 IPL points toward slowed transition from one cognitive process to another. Increased P3 amplitude, on the other hand, reflects increased allocation of neural processing resources. This may be a compensatory mechanism, allowing for equal performance with controls. These electrophysiological measures, obtained during the EF task, show promise as brain physiology-based biomarkers of burnout, contributing to its improved and objective detection. In addition, these results indicate occupational burnout is linked with objective alterations in brain physiology.
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Affiliation(s)
- Mia Pihlaja
- Behavioral Neurology Research Unit, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jari Peräkylä
- Behavioral Neurology Research Unit, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Emma-Helka Erkkilä
- Behavioral Neurology Research Unit, Tampere University Hospital, Tampere, Finland
| | - Emilia Tapio
- Behavioral Neurology Research Unit, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Maiju Vertanen
- Behavioral Neurology Research Unit, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Kaisa M. Hartikainen
- Behavioral Neurology Research Unit, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Renaud C, Lacroix A. Neuroticism, perfectionism, and emotion suppression in burnout: Implications for cognitive functioning. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-10. [PMID: 37572420 DOI: 10.1080/23279095.2023.2244623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/14/2023]
Abstract
This study aimed to investigate the relationship between burnout and cognitive functions, particularly memory, attention, and executive functions, which have been found to be negatively affected in most studies. However, the results are not consistent across studies, and there is often a discrepancy between self-reported cognitive function and objective assessment. Two possible explanations for this discrepancy are the heterogeneous profiles of individuals in burnout and their personality traits. The study administered neuropsychological tests and questionnaires to 29 participants with clinical burnout to assess their cognitive functions and the impact of perfectionism, neuroticism, and emotion suppression on subjective and objective cognitive scores. The main findings showed little or no deterioration in memory or executive functions, despite patients reporting severely impaired executive function. The study found that neuroticism and perfectionism were related to poorer self-reported executive function, while emotion suppression was related to better self-reported executive function. No relationship was found between personality traits and neuropsychological test scores, indicating a discrepancy between self-perception and objective evaluation.
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Affiliation(s)
- Charlie Renaud
- Laboratoire de Psychologie, Cognition, Comportement, Communication (LP3C), University of Rennes 2, Rennes, Bretagne, France
| | - Agnes Lacroix
- Laboratoire de Psychologie, Cognition, Comportement, Communication (LP3C), University of Rennes 2, Rennes, Bretagne, France
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Somatic symptoms in burnout in a general adult population. J Psychosom Res 2023; 168:111217. [PMID: 36921422 DOI: 10.1016/j.jpsychores.2023.111217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/05/2023] [Accepted: 03/05/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Burnout results in individual suffering and high societal costs, and is associated with somatic symptoms, anxiety and depression, calling for prevention by early identification. The objectives were to (i) determine prevalence of specific somatic symptoms in burnout, (ii) identify the symptoms, referred to as somatic symptoms of burnout (SS-B), that are particularly associated with burnout, (iii) determine their extent of association with burnout, and (iv) determine how well a certain number of SS-B differentiates participants with and without burnout in a general Swedish adult population. METHODS Cross-sectional, population-based data were used from 687 participants high on burnout, and 2544 referents based on the Shirom-Melamed Burnout Questionnaire. The Patient Health Questionnaire 15-item Somatic Symptom Severity Scale was used to assess common somatization symptoms, and the Hospital Anxiety and Depression Scale to assess anxiety and depression. RESULTS Feeling tired/having low energy, back pain, joint/limb pain, trouble sleeping, headaches, stomach pain, nausea/gas/indigestion, and constipation/loose bowels/diarrhea were most prevalent in burnout (57.2-95.0%). These symptoms, except for joint/limb pain, and dizziness, were also identified as the SS-B, with odds ratios of 2.34-12.74 and 1.95-9.11 when adjusted for background variables, and for anxiety and depression, respectively. Corresponding odds ratios for each additional number of SS-B were 1.69 and 1.52, respectively. The highest balanced accuracy (71.6%) for predicting burnout was found for ≥4 SS-B. CONCLUSION Fatigue, pain and gastrointestinal symptoms are particularly common in burnout. Further studies may show whether clinicians should consider screening for burnout when patients present with SS-B without pathophysiological explanations.
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Ketvel L, Keltikangas-Järvinen L, Pahkala K, Juonala M, Ahola-Olli A, Lehtimäki T, Viikari J, Raitakari O, Rovio S, Saarinen A. Stress-Related Exhaustion, Polygenic Cognitive Potential, and Cognitive Test Performance - A General Population Study. COGNITIVE THERAPY AND RESEARCH 2023; 47:155-167. [PMID: 36945257 PMCID: PMC10023621 DOI: 10.1007/s10608-023-10354-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 02/06/2023]
Abstract
Background We investigated whether stress-related exhaustion (chronic or short-term, and co-occurring with depression or not) is related to cognitive performance and whether polygenic cognitive potential modifies these associations. Methods The participants were from the Young Finns Study (N = 541-1273). Stress-related exhaustion was assessed using the Maastricht Questionnaire, depressive symptoms with the Beck Depression Inventory, and cognitive performance with subtests of the Cambridge Neuropsychological Test Automated Battery, measuring visuospatial learning, reaction time, sustained attention, and executive function. Cognitive performance and depression were assessed in 2011, and exhaustion in 2001, 2007, and 2011. A polygenic score for cognitive potential was calculated based on a GWAS on intelligence. Results High stress-related exhaustion, especially chronic, was associated with slower reaction time. Only clinical levels of depression were related to slower reaction time. Polygenic cognitive potential did not modify these associations. There were no differences in cognitive performance between individuals with co-occurring exhaustion and depression vs. those with only either condition. Conclusion Stress-related exhaustion, especially if chronic, seems to relate to slower reactions. Co-occurring exhaustion and depression may not have additive effects on cognitive performance. High polygenic cognitive potential may not protect from or predispose to harmful effects of exhaustion or depression on reaction time. Supplementary Information The online version contains supplementary material available at 10.1007/s10608-023-10354-z.
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Affiliation(s)
- Laila Ketvel
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, P.O. Box 21, 00014 Helsinki, Finland
| | - Liisa Keltikangas-Järvinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, P.O. Box 21, 00014 Helsinki, Finland
| | - Katja Pahkala
- Research Centre for Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Paavo Nurmi Centre and Unit for Health and Physical Activity, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku, Turku University Hospital, Turku, Finland
| | - Markus Juonala
- Department of Medicine, Division of Medicine, University of Turku, Turku University Hospital, Turku, Finland
| | - Ari Ahola-Olli
- Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center, Fimlab Laboratories, Tampere, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center, Fimlab Laboratories, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jorma Viikari
- Department of Medicine, Division of Medicine, University of Turku, Turku University Hospital, Turku, Finland
| | - Olli Raitakari
- Research Centre for Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku, Turku University Hospital, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Suvi Rovio
- Research Centre for Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku, Turku University Hospital, Turku, Finland
| | - Aino Saarinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, P.O. Box 21, 00014 Helsinki, Finland
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Occupational Burnout Is Linked with Inefficient Executive Functioning, Elevated Average Heart Rate, and Decreased Physical Activity in Daily Life - Initial Evidence from Teaching Professionals. Brain Sci 2022; 12:brainsci12121723. [PMID: 36552182 PMCID: PMC9775632 DOI: 10.3390/brainsci12121723] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/03/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Burnout is becoming a global pandemic jeopardizing brain health, with a huge impact on quality of life, available workforce, and the economy. Knowledge of the impact of burnout on cognition, physiology, and physical activity (PA) in daily life allows for an improved understanding of the health consequences and everyday ramifications of burnout. Twenty-eight volunteers participated in a three-day recording of daily physiology and PA, including heart rate (HR) and daily steps, with a wearable device. They filled in questionnaires screening for burnout (BBI-15), depression (BDI), and executive functions (EFs) in daily life (BRIEF-A). The subjects with burnout had more challenges in EFs, higher average HRs and lower numbers of steps in daily life than those without it. The BBI-15 scores correlated positively with the BDI scores and BRIEF-A indices and negatively with the awake HR variability (HRV) and daily steps. The metacognition index correlated negatively with the HRV. In conclusion, burnout is linked with compromised EFs along with alterations in cardiac physiology and PA in daily life. Such alterations may be easily detected with wearable devices, opening possibilities for novel biomarkers of burnout and other neuropsychiatric disorders. We suggest that physical activity and heart and brain health are intimately intertwined and that burnout interacts with each of them bidirectionally.
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Mahon E, Lachman ME. Voice biomarkers as indicators of cognitive changes in middle and later adulthood. Neurobiol Aging 2022; 119:22-35. [PMID: 35964541 PMCID: PMC9487188 DOI: 10.1016/j.neurobiolaging.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 06/20/2022] [Accepted: 06/26/2022] [Indexed: 11/20/2022]
Abstract
Voice prosody measures have been linked with Alzheimer's disease (AD), but it is unclear whether they are associated with normal cognitive aging. We assessed relationships between voice measures and 10-year cognitive changes in the MIDUS national sample of middle-aged and older adults ages 42-92, with a mean age of 64.09 (standard deviation = 11.23) at the second wave. Seven cognitive tests were assessed in 2003-2004 (Wave 2) and 2013-2014 (Wave 3). Voice measures were collected at Wave 3 (N = 2585) from audio recordings of the cognitive interviews. Analyses controlled for age, education, depressive symptoms, and health. As predicted, higher jitter was associated with greater declines in episodic memory, verbal fluency, and attention switching. Lower pulse was related to greater decline in episodic memory, and fewer voice breaks were related to greater declines in episodic memory and verbal fluency, although the direction of these effects was contrary to hypotheses. Findings suggest that voice biomarkers may offer a promising approach for early detection of risk factors for cognitive impairment or AD.
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Affiliation(s)
- Elizabeth Mahon
- Brandeis University, Department of Psychology, Waltham, MA, USA.
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Lindsäter E, Svärdman F, Wallert J, Ivanova E, Söderholm A, Fondberg R, Nilsonne G, Cervenka S, Lekander M, Rück C. Exhaustion disorder: scoping review of research on a recently introduced stress-related diagnosis. BJPsych Open 2022; 8:e159. [PMID: 36458830 PMCID: PMC9438479 DOI: 10.1192/bjo.2022.559] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Symptoms related to chronic stress are prevalent and entail high societal costs, yet there is a lack of international consensus regarding diagnostics and treatment. A new stress-related diagnosis, exhaustion disorder, was introduced into the Swedish version of ICD-10 in 2005. Since then, use of the diagnosis has increased rapidly. AIMS To create the first comprehensive synthesis of research on exhaustion disorder to report on the current state of knowledge. Preregistration: Open Science Framework (http://www.w3.org/1999/xlink">osf.io), doi 10.17605/OSF.IO/VFDKW. METHOD A PRISMA-guided scoping review of all empirical studies of exhaustion disorder was conducted. Searches were run in the MEDLINE, PsycInfo and Web of Science databases. Data were systematically charted and thematically categorised based on primary area of investigation. RESULTS Eighty-nine included studies were sorted into six themes relating to lived experience of exhaustion disorder (n = 9), symptom presentation and course (n = 13), cognitive functioning (n = 10), biological measures (n = 24), symptom measurement scales (n = 4) and treatment (n = 29). Several studies indicated that individuals with exhaustion disorder experience a range of psychiatric and somatic symptoms beyond fatigue, but robust findings within most thematic categories were scarce. The limited number of studies, lack of replication of findings and methodological limitations (e.g. small samples and scarcity of specified primary outcomes) preclude firm conclusions about the diagnostic construct. CONCLUSIONS More research is needed to build a solid knowledge base for exhaustion disorder. International collaboration regarding the conceptualisation of chronic stress and fatigue is warranted to accelerate the growth of evidence.
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Affiliation(s)
- Elin Lindsäter
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm, Sweden; and Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Frank Svärdman
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and Stockholm Health Care Services, Stockholm, Sweden
| | - John Wallert
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and Stockholm Health Care Services, Stockholm, Sweden
| | - Ekaterina Ivanova
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and Stockholm Health Care Services, Stockholm, Sweden
| | - Anna Söderholm
- Department of Psychology, Umeå Universitet, Umeå, Sweden
| | - Robin Fondberg
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and Stockholm Health Care Services, Stockholm, Sweden
| | - Gustav Nilsonne
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Simon Cervenka
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm, Sweden; and Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Mats Lekander
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Department of Psychology, Stockholm University, Sweden; and Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Christian Rück
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and Stockholm Health Care Services, Stockholm, Sweden
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Koutsimani P, Montgomery A. Cognitive functioning in non-clinical burnout: Using cognitive tasks to disentangle the relationship in a three-wave longitudinal study. Front Psychiatry 2022; 13:978566. [PMID: 36061283 PMCID: PMC9428402 DOI: 10.3389/fpsyt.2022.978566] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Burnout is often characterized by cognitive deficits and it has been associated with depression and anxiety. However, it is not clear whether cognitive impairment is a burnout consequence or employees with poor cognitive skills are more prone in developing burnout. Moreover, the exact nature of the association between burnout and depression, and burnout and anxiety is still unknown. Depression and anxiety are also related to cognitive impairments but their prospective associations are not fully understood. The aim of the present three-wave longitudinal study was to investigate the causality between cognitive functioning, burnout, depression, and anxiety among non-clinical burnout employees. The cause-effect associations of burnout with depression and anxiety were also explored. Perceived family support as a protective factor against cognitive decline, burnout, depression and anxiety was examined as well. A wide range of cognitive tasks tapping different cognitive domains were administered to employees of the general working population. Burnout, depression, anxiety, and perceived family support were assessed with self-reported questionnaires. Present results suggest that visuospatial functioning deficits are a burnout consequence and they indicate the role of automatic processing skills and executive functions in burnout onset. Additionally, current findings support that burnout is differentiated from depression and anxiety but it is reciprocally associated with the two psychological phenomena. Lastly, current results support the inclusion of perceived family support as an intervention to help individuals who suffer from mental health and cognitive difficulties.
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Affiliation(s)
- Panagiota Koutsimani
- Department of Educational and Social Policy, School of Social Sciences, Humanities and Arts, University of Macedonia, Thessaloniki, Greece
| | - Anthony Montgomery
- Department of Psychology, Northumbria University Newcastle, Newcastle upon Tyne, United Kingdom
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Gavelin HM, Domellöf ME, Åström E, Nelson A, Launder NH, Neely AS, Lampit A. Cognitive function in clinical burnout: A systematic review and meta-analysis. WORK AND STRESS 2021. [DOI: 10.1080/02678373.2021.2002972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
| | | | | | - Andreas Nelson
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
| | - Nathalie H. Launder
- Academic Unit for Psychiatry of Old Age, University of Melbourne, Parkville, Australia
| | - Anna Stigsdotter Neely
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
- Department of Social Sciences, Technology and Arts, Luleå University of Technology, Luleå, Sweden
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Amit Lampit
- Academic Unit for Psychiatry of Old Age, University of Melbourne, Parkville, Australia
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Abstract
OBJECTIVES Burnout is a state of exhaustion resulting from prolonged and excessive workplace stress. We sought to examine biological underpinnings of burnout, focussing on mechanisms and physical consequences. METHODS We searched the literature on burnout and evaluated studies examining biological parameters in patient populations (i.e. 'clinical' burnout) as well as in individuals from the general population judged as having some degree of burnout evaluated using a dimensional approach. RESULTS Findings suggest that burnout is associated with sustained activation of the autonomic nervous system and dysfunction of the sympathetic adrenal medullary axis, with alterations in cortisol levels. Limited studies have also shown altered immune function and changes in other endocrine systems. Consequences of burnout include increased allostatic load, structural and functional brain changes, excito-toxicity, systemic inflammation, immunosuppression, metabolic syndrome, cardiovascular disease and premature death. Limitations of studies include variability in study populations, low specificity of burnout measures, and mostly cross-sectional studies precluding examination of changes across the course of burnout. CONCLUSIONS Further examination of biological mechanisms of burnout would benefit from more homogeneous clinical samples, challenge tests and prospective studies. This would assist in differentiation from conditions such as depression and aid with development of specific treatment targets for burnout.
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Affiliation(s)
- Adam Bayes
- School of Psychiatry, UNSW, Sydney, Australia.,Black Dog Institute, Sydney, Australia
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Johansen T, Øyeflaten I, Eriksen HR, Lyby PS, Dittrich WH, Holsen I, Jakobsen H, Del Risco Kollerud R, Jensen C. Sustained Attention and Working Memory Predict the Number of Days on Health-Related Benefits in the Year Following Occupational Rehabilitation. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:592-603. [PMID: 33471320 PMCID: PMC8298247 DOI: 10.1007/s10926-020-09944-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/03/2020] [Indexed: 06/12/2023]
Abstract
Purpose The objective of this study was to investigate the association between cognitive and emotional functioning and the number of days on health-related benefits such as sick leave, work assessment allowance and disability pension. We investigated whether cognitive and emotional functioning at the start of rehabilitation and the change from the start to the end of rehabilitation predicted the number of days on health-related benefits in the year after occupational rehabilitation. Methods A sample of 317 individuals (age 19-67 years), mainly diagnosed with a musculoskeletal or mental and behavioural ICD-10 disorder, participated. The sample was stratified depending on the benefit status in the year before rehabilitation. Those receiving health-related benefits for the full year comprised the work assessment allowance and disability pension (WAA) group and those receiving benefits for less than a year comprised the sick leave (SL) group. The participants were administered cognitive and emotional computerised tests and work and health questionnaires at the beginning and end of rehabilitation. The cumulative number of days on health-related benefits during 12 months after rehabilitation was the primary outcome variable and age, gender, educational level, subjective health complaints, anxiety, and depression were controlled for in multiple regression analyses. Results The WAA group (n = 179) was significantly impaired at baseline compared to the SL group (n = 135) in focused attention and executive function, and they also scored worse on work and health related variables. Higher baseline scores and change scores from the start to the end of rehabilitation, for sustained attention, were associated with fewer number of health-related benefit days in the WAA group, while higher baseline scores for working memory were associated with fewer number of health-related benefit days in the SL group. Conclusions New knowledge about attention and memory and return to work in individuals with different benefit status may pave the way for more targeted programme interventions. Rehabilitation programmes could benefit from designing interventions that respectively improve sustain attention and working memory related to working life in individuals on sick leave or work assessment allowance and disability pension.
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Affiliation(s)
- Thomas Johansen
- Norwegian National Advisory Unit on Occupational Rehabilitation, Haddlandsvegen 20, 3864, Rauland, Norway.
| | - Irene Øyeflaten
- Norwegian National Advisory Unit on Occupational Rehabilitation, Haddlandsvegen 20, 3864, Rauland, Norway
- NORCE, Norwegian Research Centre, Bergen, Norway
| | - Hege R Eriksen
- Department of Sport, Food and Natural Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Winand H Dittrich
- FOM Hochschule, KCI Competence Center for Behavioral Economics, Frankfurt, Germany
| | - Inge Holsen
- Red Cross Haugland Rehabilitation Center, Flekke, Norway
| | | | - Ruby Del Risco Kollerud
- Norwegian National Advisory Unit on Occupational Rehabilitation, Haddlandsvegen 20, 3864, Rauland, Norway
| | - Chris Jensen
- Norwegian National Advisory Unit on Occupational Rehabilitation, Haddlandsvegen 20, 3864, Rauland, Norway
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Pakarinen S, Lohilahti J, Sokka L, Korpela J, Huotilainen M, Müller K. Auditory deviance detection and involuntary attention allocation in occupational burnout-A follow-up study. Eur J Neurosci 2021; 55:2592-2611. [PMID: 34415092 DOI: 10.1111/ejn.15429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 07/25/2021] [Accepted: 08/06/2021] [Indexed: 11/30/2022]
Abstract
Here, we investigated the central auditory processing and attentional control associated with both recovery and prolongation of occupational burnout. We recorded the event-related brain potentials N1, P2, mismatch negativity (MMN) and P3a to nine changes in speech sounds and to three rarely presented emotional (happy, angry and sad) utterances from individuals with burnout (N = 16) and their matched controls (N = 12). After the 5 years follow-up, one control had acquired burnout, half (N = 8) of the burnout group had recovered, and the other half (prolonged burnout) still had burnout. The processing of acoustical changes in speech sounds was mainly intact. Prolongation of the burnout was associated with a decrease in MMN amplitude and an increase in P3a amplitude for the happy stimulus. The results suggest that, in the absence of interventions, burnout is a persistent condition, associated with alterations of attentional control, that may be amplified with the prolongation of the condition.
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Affiliation(s)
- Satu Pakarinen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | | | - Laura Sokka
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jussi Korpela
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Minna Huotilainen
- CICERO Learning, Faculty of Education, and Cognitive Brain Research Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Kiti Müller
- Faculty of Medicine, Department of Neurosciences, University of Helsinki, Helsinki, Finland
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Nelson A, Gavelin HM, Boraxbekk CJ, Eskilsson T, Josefsson M, Slunga Järvholm L, Neely AS. Subjective cognitive complaints in patients with stress-related exhaustion disorder: a cross sectional study. BMC Psychol 2021; 9:84. [PMID: 34006315 PMCID: PMC8132387 DOI: 10.1186/s40359-021-00576-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/22/2021] [Indexed: 01/23/2023] Open
Abstract
Background Stress-related exhaustion is associated with cognitive impairment as measured by both subjective cognitive complaints (SCCs) and objective cognitive test performance. This study aimed to examine how patients diagnosed with exhaustion disorder differ from healthy control participants in regard to levels and type of SCCs, and if SCCs are associated with cognitive test performance and psychological distress. Methods We compared a group of patients with stress-related exhaustion disorder (n = 103, female = 88) with matched healthy controls (n = 58, female = 47) cross-sectionally, concerning the type and magnitude of self-reported SCCs. We furthermore explored the association between SCCs and cognitive test performance as well as with self-reported depression, anxiety and burnout levels, in the patient and the control group, respectively. Results Patients reported considerably more cognitive failures and were more likely than controls to express memory failures in situations providing few external cues and reminders in the environment. In both groups, SCCs were associated with demographic and psychological factors, and not with cognitive test performance. Conclusion Our findings underline the high burden of cognitive problems experienced by patients with exhaustion disorder, particularly in executively demanding tasks without external cognitive support. From a clinical perspective, SCCs and objective cognitive test performance may measure different aspects of cognitive functioning, and external cognitive aids could be of value in stress rehabilitation. Trial registration Participants were recruited as part of the Rehabilitation for Improved Cognition (RECO) study (ClinicalTrials.gov: NCT03073772). Date of registration: 8 March 2017 Supplementary Information The online version contains supplementary material available at 10.1186/s40359-021-00576-9.
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Affiliation(s)
- Andreas Nelson
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden. .,Department of Anaesthesiology, Central Hospital of Karlstad, Karlstad, Region Värmland, Sweden.
| | - Hanna Malmberg Gavelin
- Academic Unit for Psychiatry of Old Age, University of Melbourne, Melbourne, Australia.,Department of Psychology, Umeå University, Umeå, Sweden
| | - Carl-Johan Boraxbekk
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden.,Institute of Sports Medicine Copenhagen (ISMC), Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.,Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Amager and Hvidovre, Denmark
| | - Therese Eskilsson
- Department of Public Health and Clinical Medicine, Section for Sustainable Health, Umeå University, Umeå, Sweden.,Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Maria Josefsson
- Centre for Demographic and Ageing Research (CEDAR), Umeå University, Umeå, Sweden.,Department of Statistics Umeå, University, Umeå, Sweden
| | - Lisbeth Slunga Järvholm
- Department of Public Health and Clinical Medicine, Section for Sustainable Health, Umeå University, Umeå, Sweden
| | - Anna Stigsdotter Neely
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden.,Department of Social Sciences, Technology and Arts, Luleå University of Technology, Luleå, Sweden.,Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
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15
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Dalgaard VL, Hviid Andersen J, Pedersen AD, Andersen LP, Eskildsen A. Cognitive impairments and recovery in patients with work-related stress complaints - four years later. Stress 2021; 24:294-302. [PMID: 32812459 DOI: 10.1080/10253890.2020.1797673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Patients on sick leave due to work-related stress often present with cognitive complaints. The primary aim of this prospective cohort study was to examine potential long-term consequences of previous ongoing work-related stress in terms of cognitive functioning four years after initial professional care seeking. We tested a group of patients with work-related stress complaints with a comprehensive neuropsychological test battery. Patients were examined at a department of occupational medicine and tested at baseline, one-year follow-up and four-year follow-up. At each time point, we compared the performance of patients with healthy controls matched pairwise on sex, age and length of education. This paper presents the results from the four-year follow-up. Patients improved on their neuropsychological test performance during the four years but the main improvements took place during the first year. At baseline, the main impairments in the patient group concerned executive function and mental speed. At four-year follow-up, patients displayed slightly lower scores on the neuropsychological tests relative to controls but only the difference on immediate memory was significant corresponding to a small effect size (Cohen's d). More than half of the patients who participated in the four-year follow-up reported that they felt only slightly or partially recovered. The level of work participation among the former patients improved considerably during the four-year follow-up period.Lay SummaryThis study examines the long-term consequences of work-related stress in terms of cognitive functioning and recovery four years after initial professional care seeking. After four years, patients continued to display significantly lower memory scores than controls but no other significant differences between the groups were found on neuropsychological tests. Levels of work participation among patients improved considerably over time, yet, more than half of the former patients who participated in the four-year follow-up did not feel completely recovered.
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Affiliation(s)
- Vita Ligaya Dalgaard
- Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland, University Clinic, Herning, Denmark
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus C, Denmark
| | - Johan Hviid Andersen
- Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland, University Clinic, Herning, Denmark
| | | | - Lars Peter Andersen
- Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland, University Clinic, Herning, Denmark
| | - Anita Eskildsen
- Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland, University Clinic, Herning, Denmark
- Department of Affective Disorders, Aarhus University Hospital - Skejby, Aarhus N, Denmark
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16
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Ellbin S, Jonsdottir IH, Eckerström C, Eckerström M. Self-reported cognitive impairment and daily life functioning 7-12 years after seeking care for stress-related exhaustion. Scand J Psychol 2021; 62:484-492. [PMID: 33728711 DOI: 10.1111/sjop.12722] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/17/2020] [Accepted: 01/31/2021] [Indexed: 11/27/2022]
Abstract
The overall aim of this study was to investigate self-reported cognitive difficulties, daily life activities, and health/sleep factors in former patients with exhaustion disorder (ED) who still fulfill the clinical criteria for exhaustion 7-12 years after seeking care. The Sahlgrenska Self-reported Cognitive Impairment Questionnaire (SASCI-Q) was used to measure cognitive difficulties, daily life activities, and health/sleep factors. Three groups were compared: previous patients still judged to be clinically exhausted seven years or more after seeking care (n = 51); previous patients considered clinically recovered (n = 98); and healthy controls (n = 50). Patients who still fulfilled the diagnostic criteria for ED reported widespread problems related to cognition, fatigue, and daily life functioning compared to the clinically recovered group. Furthermore, despite no longer fulfilling the clinical criteria, the recovered patients still reported more problems related to cognitive functioning and fatigue compared to healthy controls. Thus, this group appeared intermediary between the non-recovered group and healthy controls regarding self-reported cognitive functioning. To conclude, ED may have considerable negative long-term effects, and it is possible that some of these residual symptoms, particularly the cognitive problems and persistent fatigue, are permanent in some patients. Preventive measures should be the primary focus for all stakeholders, since the consequences of stress-related mental health problems seem to be extensive and long-lasting.
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Affiliation(s)
- Susanne Ellbin
- Institute of Stress Medicine, Region Västra Götaland, Gothenburg, Sweden
| | - Ingibjörg H Jonsdottir
- Institute of Stress Medicine, Region Västra Götaland, Gothenburg, Sweden.,School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Carl Eckerström
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marie Eckerström
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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17
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Sjörs Dahlman A, Jonsdottir IH, Hansson C. The hypothalamo-pituitary-adrenal axis and the autonomic nervous system in burnout. HANDBOOK OF CLINICAL NEUROLOGY 2021; 182:83-94. [PMID: 34266613 DOI: 10.1016/b978-0-12-819973-2.00006-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Burnout constitutes a serious health concern in the modern working environment. It is a stress-related condition that has developed as a result of a prolonged psychosocial stress exposure causing a persistent mismatch between demands and resources. The main symptom is emotional exhaustion, but physical fatigue, diminished professional efficacy, cynicism, and cognitive impairments are also associated with this condition. Burnout has been used both as a psychologic term in occupational settings and as a clinical diagnosis in patient populations, and there is currently no universally accepted definition and diagnostic criteria of burnout. It has been hypothesized that the two main stress response systems, the autonomic nervous system (ANS) and the hypothalamus-pituitary-adrenal axis (HPA axis), are involved in the pathogenesis of burnout. A common hypothesis is that in the early stages of chronic stress, the HPA axis and sympathetic ANS activity tend to be higher, while it will decrease with a longer duration of chronic stress to ultimately reach a state of hypoactivity in clinical burnout. The current research in this field shows many contradictory results. Thus there is no compelling evidence of either ANS or HPA dysfunction in burnout. However, there is partial support for the hypothesis of HPA and sympathetic hyperactivity in early stages, and HPA hyporeactivity and low vagal activity in more severe burnout cases, but high-quality studies investigating the causal links are still lacking.
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Affiliation(s)
- Anna Sjörs Dahlman
- Institute of Stress Medicine, Region Västra Götaland, Gothenburg, Sweden; Human Factors Department, Swedish National Road and Transport Research Institute, Gothenburg, Sweden.
| | - Ingibjörg H Jonsdottir
- Institute of Stress Medicine, Region Västra Götaland, Gothenburg, Sweden; School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Caroline Hansson
- Institute of Stress Medicine, Region Västra Götaland, Gothenburg, Sweden; Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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18
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Skau S, Jonsdottir IH, Sjörs Dahlman A, Johansson B, Kuhn HG. Exhaustion disorder and altered brain activity in frontal cortex detected with fNIRS. Stress 2021; 24:64-75. [PMID: 32510268 DOI: 10.1080/10253890.2020.1777972] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Patients with stress-related Exhaustion Disorder (ED) have problems with memory and executive function. These problems have been associated with deviant activity in prefrontal cortex (PFC). We investigated cognitive performance and functional activity in the PFC during prolonged mental activity in patients with ED (n = 20, 16 women) with a mean duration since diagnosis of 46 ± 23 months in comparison to healthy individuals (n = 20, 12 women). A block of six neuropsychological tests was performed in a sequence that was repeated once. The brain imaging technique, functional near infrared spectroscopy (fNIRS) was used for all tests. There were no differences between the groups in terms of changes over time, i.e. difference between first and second test block. In the Stroop-Simon test, the controls showedhigher functional activity in the frontal cortex. In the left ventrolateral PFC, we observed an increased activity in controls in the incongruent compared to the congruent trials, whereas no changes were detected in the ED patient group. During processing speed tasks, only ED patients showed higher functional activity in right dorsolateral PFC. The ED patients reported lower subjective energy level and they also performed less well on a mental control task compared to healthy individuals. In conclusion, ED patients showed altered functional activity compared to controls, indicating that ED patients process information differently in the prefrontal cortex, but the functional activity did not change during the 2½ hr procedure, as revealed by the test-retest design. Lay summary In this paper we show that patient with exhaustion disorder have a reduced functional activity in the prefrontal cortex. This functional activity was not affected by 2.5 hours mental activity.
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Affiliation(s)
- Simon Skau
- Instituteof Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ingibjörg H Jonsdottir
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Institute of Stress Medicine, Gothenburg, Sweden
| | - Anna Sjörs Dahlman
- Institute of Stress Medicine, Gothenburg, Sweden
- Swedish National Road and Transport Research Institute, Gothenburg, Sweden
| | - Birgitta Johansson
- Instituteof Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - H Georg Kuhn
- Instituteof Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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19
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Kulikowski K. Cognitive abilities - a new direction in burnout research. EUROPEAN JOURNAL OF WORK AND ORGANIZATIONAL PSYCHOLOGY 2020. [DOI: 10.1080/1359432x.2020.1841284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Konrad Kulikowski
- Faculty of Management, University of Social Sciences, Społeczna Akademia Nauk, Łódz, Poland
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20
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Thomée S, Österberg K, Rådman L, Jakobsson K. Cognition and mental wellbeing after electrical accidents: a survey and a clinical study among Swedish male electricians. Int Arch Occup Environ Health 2020; 93:683-696. [PMID: 32036424 PMCID: PMC7320954 DOI: 10.1007/s00420-020-01520-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 01/20/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose was to examine long-term consequences of exposure to electrical current passing through the body. We investigated (1) whether electricians after having experienced an electrical accident report more cognitive problems and lower mental wellbeing and (2) have objectively verifiable reduced cognitive function; and (3) which circumstances at the time of the accident affect long-term subjective cognitive function and mental wellbeing? METHODS A survey of male electricians who had experienced electrical accidents (n = 510) and a clinical study in a subsample (n = 23) who reported residual health problems was carried out. Both groups were examined regarding subjective cognitive function (Euroquest-9) and mental wellbeing (Symptom Checklist-90 subscales). The clinical study included neuropsychological tests of memory, attention, spatial function, and premorbid intellectual capacity. A matched control group was retrieved from reference data. RESULTS The survey participants reported more cognitive problems and lower mental wellbeing than referents. Of the examined circumstances, having experienced mortal fear at the time of the accident and health complaints, especially mental symptoms, for > 1 week after the accident were the most significant risk factors for later subjective cognitive problems and lower mental wellbeing. The only statistically significant difference in neuropsychological tests was better performance in part of the memory tests by the clinical study group compared to the control group. CONCLUSIONS The participants reported more cognitive problems and lower mental wellbeing than referents, but no long-term objective cognitive dysfunction was detected. Emotional response at the time of the accident and health complaints in the aftermath of the accident may constitute important indications for medical and psychological follow-ups.
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Affiliation(s)
- Sara Thomée
- Department of Psychology, University of Gothenburg, P.O. Box 500, 405 30, Gothenburg, Sweden.
| | - Kai Österberg
- Department of Psychology, Lund University, P.O. Box 213, 221 00, Lund, Sweden
| | - Lisa Rådman
- Department of Occupational and Environmental Medicine, Örebro University Hospital, 701 85, Örebro, Sweden.,Department of Physiotherapy, School of Medical Sciences, Örebro University, 701 82, Örebro, Sweden
| | - Kristina Jakobsson
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, P.O. Box 414, 405 30, Gothenburg, Sweden.,Occupational and Environmental Medicine, Sahlgrenska University Hospital, P.O. Box 414, 405 30, Gothenburg, Sweden
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21
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Johansen T, Jensen C, Eriksen HR, Lyby PS, Dittrich WH, Holsen IN, Jakobsen H, Øyeflaten I. Occupational Rehabilitation Is Associated With Improvements in Cognitive Functioning. Front Psychol 2019; 10:2233. [PMID: 31649584 PMCID: PMC6795755 DOI: 10.3389/fpsyg.2019.02233] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/17/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction Occupational rehabilitation may be offered to workers on long-term sick leave who often report problems with cognitive functioning, anxiety, depression, pain, and reduced work ability. The empirical knowledge is sparce on how occupational rehabilitation may influence cognitive and emotional functioning and patients have not previously been subjected to comprehensive objective testing. The main aim of this study was to assess possible changes in cognitive and emotional functioning such as memory, attention, executive function, and emotion recognition among patients in occupational rehabilitation. Methods A large sample of 280 sick-listed workers referred to inpatient and outpatient occupational rehabilitation was recruited. The rehabilitation programs had a mean duration of 28 days and comprised physical activity, cognitive behavior treatment components and collaboration with the workplace. A pre-post design was applied to investigate possible changes in cognitive and emotional functioning (primary outcomes) and work and health measures (secondary outcomes), comparing the rehabilitation group with a control group of 70 healthy workers. Individuals in the control group were tested at random time points with an approximately 28 day interval between pre- and post-test, thus coinciding with the duration of rehabilitation. Repeated measures analysis of variance was used for the main analyses. Results Compared to the control group, the rehabilitation group had greater gains from pre- to post-test in focused and sustained attention, as well as greater improvements in work ability and reduction in subjective health complaints (SHC), helplessness, pain, pain related to work, anxiety, and depression. In the rehabilitation group, exploratory correlational analysis indicated that improvements in focused and sustained attention were associated with improvements in return-to-work self-efficacy, work ability as well as a reduction in SHC. Conclusion The sick-listed workers improved in focused and sustained attention and work and health measures after participating in occupational rehabilitation. This study is one of the first to systematically investigate changes in cognitive and emotional functioning during occupational rehabilitation. Clinical practice should benefit from increased knowledge about all cognitive functions and should be specifically aware of the improvements in focused and sustained attention, while memory, executive function and emotion recognition remained unchanged. The results can be used as a motivation to tailor specific interventions to gain further improvements in all cognitive and emotional functions.
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Affiliation(s)
- Thomas Johansen
- National Advisory Unit on Occupational Rehabilitation, Rauland, Norway
| | - Chris Jensen
- National Advisory Unit on Occupational Rehabilitation, Rauland, Norway.,Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hege R Eriksen
- Department of Sport, Food and Natural Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Winand H Dittrich
- FOM Hochschule, KCI Competence Center for Behavioral Economics, Frankfurt, Germany
| | - Inge N Holsen
- Red Cross Haugland Rehabilitation Center, Flekke, Norway
| | | | - Irene Øyeflaten
- National Advisory Unit on Occupational Rehabilitation, Rauland, Norway.,Norwegian Research Centre, Bergen, Norway
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22
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Jonsdottir IH, Nordlund A, Ellbin S, Ljung T, Glise K, Währborg P, Sjörs A, Wallin A. Working memory and attention are still impaired after three years in patients with stress-related exhaustion. Scand J Psychol 2017; 58:504-509. [DOI: 10.1111/sjop.12394] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 08/29/2017] [Indexed: 11/29/2022]
Affiliation(s)
| | - Arto Nordlund
- Institute of Neuroscience and Physiology; University of Gothenburg; Mölndal Sweden
| | | | - Thomas Ljung
- Mid Sweden University and Jämtland County Council; Östersund Sweden
| | | | - Peter Währborg
- Institute of Medicine; University of Gothenburg; Gothenburg Sweden
| | - Anna Sjörs
- Institute of Stress Medicine; Gothenburg Sweden
| | - Anders Wallin
- Institute of Neuroscience and Physiology; University of Gothenburg; Mölndal Sweden
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23
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Eskilsson T, Slunga Järvholm L, Malmberg Gavelin H, Stigsdotter Neely A, Boraxbekk CJ. Aerobic training for improved memory in patients with stress-related exhaustion: a randomized controlled trial. BMC Psychiatry 2017; 17:322. [PMID: 28865430 PMCID: PMC5581420 DOI: 10.1186/s12888-017-1457-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 08/08/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Patients with stress-related exhaustion suffer from cognitive impairments, which often remain after psychological treatment or work place interventions. It is important to find effective treatments that can address this problem. Therefore, the aim of this study was to investigate the effects on cognitive performance and psychological variables of a 12-week aerobic training program performed at a moderate-vigorous intensity for patients with exhaustion disorder who participated in a multimodal rehabilitation program. METHODS In this open-label, parallel, randomized and controlled trial, 88 patients diagnosed with exhaustion disorder participated in a 24-week multimodal rehabilitation program. After 12 weeks in the program the patients were randomized to either a 12-week aerobic training intervention or to a control group with no additional training. Primary outcome measure was cognitive function, and secondary outcome measures were psychological health variables and aerobic capacity. RESULTS In total, 51% patients in the aerobic training group and 78% patients in the control group completed the intervention period. The aerobic training group significantly improved in maximal oxygen uptake and episodic memory performance. No additional improvement in burnout, depression or anxiety was observed in the aerobic group compared with controls. CONCLUSION Aerobic training at a moderate-vigorous intensity within a multimodal rehabilitation program for patients with exhaustion disorder facilitated episodic memory. A future challenge would be the clinical implementation of aerobic training and methods to increase feasibility in this patient group. TRIAL REGISTRATION ClinicalTrials.gov: NCT03073772 . Retrospectively registered 21 February 2017.
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Affiliation(s)
- Therese Eskilsson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE- 901 87, Umeå, Sweden.
| | - Lisbeth Slunga Järvholm
- 0000 0001 1034 3451grid.12650.30Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | | | - Anna Stigsdotter Neely
- 0000 0001 0721 1351grid.20258.3dDepartment of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
| | - Carl-Johan Boraxbekk
- 0000 0004 0646 8202grid.411905.8Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark ,0000 0001 1034 3451grid.12650.30Center for Demographic and Aging Research (CEDAR), Umeå University, Umeå, Sweden ,0000 0001 1034 3451grid.12650.30Umeå Centre for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden
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24
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Riedrich K, Weiss EM, Dalkner N, Reininghaus E, Papousek I, Schwerdtfeger A, Lackner HK, Reininghaus B. [Cognitive impairments accompanying the burnout syndrome - a review]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2017; 31:24-31. [PMID: 28251576 DOI: 10.1007/s40211-017-0217-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 02/08/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The rising prevalence of the burnout syndrome has increasingly moved it into the focus of scientific interest. In addition to emotional exhaustion and depersonalization, particularly reduced personal accomplishment has strong societal and economic effects. In recent years reduced personal accomplishment has increasingly been linked to cognitive impairment. However, up to now only a few studies have objectively assessed cognitive deficits in burnout patients. This article gives an overview of 16 studies which examined cognitive abilities in burnout patients. The findings are partly contradictory, probably due to methodical differences. Consensus has emerged concerning impairments of executive functions, i.a. vigilance, and memory updating and monitoring. Multifactorial causation may underlie the cognitive impairments. OUTLOOK Targeted longitudinal studies are necessary in order to identify the affected cognitive functions and be able to make causal inferences on links between the burnout syndrome and specific cognitive impairments.
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Affiliation(s)
- Karin Riedrich
- Therapiezentrum Justuspark BVA, Bad Hall, Linzer Straße 7, 4540, Bad Hall, Österreich. .,Abteilung für Biologische Psychologie, Karl-Franzens-Universität Graz, Universitätsplatz 2/DG, 8010, Graz, Österreich.
| | - Elisabeth M Weiss
- Abteilung für Biologische Psychologie, Karl-Franzens-Universität Graz, Universitätsplatz 2/DG, 8010, Graz, Österreich
| | - Nina Dalkner
- Universitätsklinik für Psychiatrie, Medizinische Universität Graz, Auenbruggerplatz 2, 8036, Graz, Österreich
| | - Eva Reininghaus
- Universitätsklinik für Psychiatrie, Medizinische Universität Graz, Auenbruggerplatz 2, 8036, Graz, Österreich
| | - Ilona Papousek
- Abteilung für Biologische Psychologie, Karl-Franzens-Universität Graz, Universitätsplatz 2/DG, 8010, Graz, Österreich
| | - Andreas Schwerdtfeger
- Abteilung für Gesundheitspsychologie, Karl-Franzens-Universität Graz, Universitätsplatz 2/DG, 8010, Graz, Österreich
| | - Helmut K Lackner
- Institut für Physiologie, Medizinische Universität Graz, Auenbruggerplatz 2, 8036, Graz, Österreich
| | - Bernd Reininghaus
- Therapiezentrum Justuspark BVA, Bad Hall, Linzer Straße 7, 4540, Bad Hall, Österreich
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25
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Eskildsen A, Andersen LP, Pedersen AD, Andersen JH. Cognitive impairments in former patients with work-related stress complaints - one year later. Stress 2016; 19:559-566. [PMID: 27578321 DOI: 10.1080/10253890.2016.1222370] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Patients on sick leave due to work-related stress often present with cognitive impairments. The aim of this prospective cohort study was to examine the long-term consequences of prolonged work-related stress in terms of cognitive functioning one year after initial professional care seeking. We tested a group of patients with work-related stress with a comprehensive neuropsychological test battery at two occasions, one year apart. At both time points, we compared the performance of patients with healthy controls matched pairwise on sex, age and length of education. This paper presents the results from the one-year follow-up. When adjusting for practice effects, patients improved on measures of prospective memory and processing speed. However, patients continued to perform worse than controls on all tests, though only half of the comparisons reached statistical significance. The effect sizes of the differences between the two groups at one-year follow-up were small to medium. In conclusion, former patients with prolonged work-related stress improved, but they continued to perform worse than controls after one year. In the acute phase, the largest impairments were related to executive function and mental speed but at follow-up memory impairments also became apparent.
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Affiliation(s)
- Anita Eskildsen
- a Department of Occupational Medicine , Danish Ramazzini Center, The Regional Hospital West Jutland - University Research Clinic , Herning , Denmark
| | - Lars Peter Andersen
- a Department of Occupational Medicine , Danish Ramazzini Center, The Regional Hospital West Jutland - University Research Clinic , Herning , Denmark
| | - Anders Degn Pedersen
- b Department of Psychology and Behavioral Sciences , Aarhus University , Aarhus , Denmark
| | - Johan Hviid Andersen
- a Department of Occupational Medicine , Danish Ramazzini Center, The Regional Hospital West Jutland - University Research Clinic , Herning , Denmark
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Getting better, but not well: A 1.5 year follow-up of cognitive performance and cortisol levels in clinical and non-Clinical burnout. Biol Psychol 2016; 117:89-99. [DOI: 10.1016/j.biopsycho.2016.02.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 01/21/2016] [Accepted: 02/24/2016] [Indexed: 11/23/2022]
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27
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Exhaustion-related changes in cardiovascular and cortisol reactivity to acute psychosocial stress. Physiol Behav 2015. [DOI: 10.1016/j.physbeh.2015.07.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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28
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Grossi G, Perski A, Osika W, Savic I. Stress-related exhaustion disorder - clinical manifestation of burnout? A review of assessment methods, sleep impairments, cognitive disturbances, and neuro-biological and physiological changes in clinical burnout. Scand J Psychol 2015; 56:626-36. [DOI: 10.1111/sjop.12251] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 07/20/2015] [Indexed: 01/31/2023]
Affiliation(s)
- Giorgio Grossi
- Stress Research Institute; Stockholm University; Stockholm Sweden
- The Stress Clinic Foundation; Stockholm Sweden
- Center for Social Sustainability; Department of Neurobiology, Care Sciences and Society; Karolinska institute; Stockholm Sweden
| | - Aleksander Perski
- Stress Research Institute; Stockholm University; Stockholm Sweden
- The Stress Clinic Foundation; Stockholm Sweden
| | - Walter Osika
- Center for Social Sustainability; Department of Neurobiology, Care Sciences and Society; Karolinska institute; Stockholm Sweden
| | - Ivanka Savic
- Department of Women's and Children's Health, and Neurology Clinic; Karolinska Institute and Hospital; Stockholm Sweden
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Eskildsen A, Andersen LP, Pedersen AD, Vandborg SK, Andersen JH. Work-related stress is associated with impaired neuropsychological test performance: a clinical cross-sectional study. Stress 2015; 18:198-207. [PMID: 25556981 DOI: 10.3109/10253890.2015.1004629] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Patients on sick leave due to work-related stress often complain about impaired concentration and memory. However, it is undetermined how widespread these impairments are, and which cognitive domains are most long-term stress sensitive. Previous studies show inconsistent results and are difficult to synthesize. The primary aim of this study was to examine whether patients with work-related stress complaints have cognitive impairments compared to a matched control group without stress. Our secondary aim was to examine whether the level of self-reported perceived stress is associated with neuropsychological test performance. We used a broad neuropsychological test battery to assess 59 outpatients with work-related stress complaints (without major depression) and 59 healthy controls. We matched the patients and controls pairwise by sex, age and educational level. Compared to controls, patients generally showed mildly reduced performance across all the measured domains of the neuropsychological test battery. However, only three comparisons reached statistical significance (p < 0.05). Effect sizes (Cohen's d) were generally small to medium. The most pronounced differences between patients and controls were seen on tests of prospective memory, speed and complex working memory. There were no statistical significant associations between self-reported perceived stress level and neuropsychological test performance. In conclusion, we recommend that cognitive functions should be considered when evaluating patients with work-related stress complaints, especially when given advice regarding return to work. Since this study had a cross-sectional design, it is still uncertain whether the impairments are permanent. Further study is required to establish causal links between work-related stress and cognitive deficits.
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Affiliation(s)
- Anita Eskildsen
- Danish Ramazzini Centre, Department of Occupational Medicine, The Regional Hospital West Jutland - University Research Clinic , Herning , Denmark
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Gavelin HM, Boraxbekk CJ, Stenlund T, Järvholm LS, Neely AS. Effects of a process-based cognitive training intervention for patients with stress-related exhaustion. Stress 2015; 18:578-88. [PMID: 26305186 DOI: 10.3109/10253890.2015.1064892] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Stress-related exhaustion has been linked to a pattern of selective cognitive impairments, mainly affecting executive functioning, attention and episodic memory. Little is known about potential treatments of these cognitive deficits. The purpose of this study was to evaluate the effects of a process-based cognitive training intervention, designed to target the specific cognitive impairments associated with stress-related exhaustion. To this end, patients diagnosed with exhaustion disorder (ED) were randomized to either a multimodal stress rehabilitation program with the addition of a process-based cognitive training intervention (training group, n = 27) or a treatment-as-usual control condition, consisting of multimodal stress rehabilitation with no additional training (control group, n = 32). Treatment effects were evaluated through an extensive cognitive test battery, assessing both near and far transfer effects, as well as self-report forms regarding subjective cognitive complaints and burnout levels. Results showed pronounced training-related improvements on the criterion updating task (p < 0.001). Further, evidence was found of selective near transfer effects to updating (p = 0.01) and episodic memory (p = 0.04). Also, the trained group reported less subjective memory complaints (p = 0.02) and levels of burnout decreased for both groups, but more so for the trained group (p = 0.04), following the intervention. These findings suggest that process-based cognitive training may be a viable method to address the cognitive impairments associated with ED.
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Affiliation(s)
| | - Carl-Johan Boraxbekk
- b Center for Demographic and Aging Research (CEDAR), Umeå Centre for Functional Brain Imaging, Umeå University , Umea , Sweden
| | - Therese Stenlund
- c Division of Physiotherapy, Department of Community Medicine and Rehabilitation , Umeå University , Umea , Sweden
| | - Lisbeth Slunga Järvholm
- d Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine , Umeå University , Umea , Sweden , and
| | - Anna Stigsdotter Neely
- a Department of Psychology , Umeå University , Umea , Sweden
- e Department of Social and Psychological Studies , Karlstad University , Karlstad , Sweden
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Karlson B, Jönsson P, Österberg K. Long-term stability of return to work after a workplace-oriented intervention for patients on sick leave for burnout. BMC Public Health 2014; 14:821. [PMID: 25106094 PMCID: PMC4137088 DOI: 10.1186/1471-2458-14-821] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 08/05/2014] [Indexed: 11/29/2022] Open
Abstract
Background The period from the mid-1990s to the mid-2000s saw a rapid increase in long-term sick leave in Sweden, primarily due to mental illness and often related to job burnout. This led to an urge for effective treatment programs that could prevent the often long sick leaves. In 2010 we presented a newly developed work-place intervention method, showing that 89% of the intervention group had returned to work at a 1.5 year follow-up, compared to 73% of the control group. The main aim of this study was to assess the long-term stability of these promising results. Methods Sick leave registry data from the Regional Social Insurance Office were analyzed for an additional year (50 weeks) beyond the original 1.5 year period (80 weeks). Data from 68 matched pairs of intervention participants (IP) and controls were available. The proportions of participants being on full-time sick leave versus having returned to work to any extent were computed for every 10th week. Generalized estimating equations were used with GROUP (IP versus controls) as between-subjects factor, WEEKS and AGE as covariates, and return-to-work (RTW) as dependent variable. Significant differences (Wald χ2 with α ≤ .05) was followed up with polynomial contrasts. Individual relapses to higher degrees of sick leave (e.g. from 50% to 100%) and whether partial RTW led to later full-time RTW, were also analyzed. Results The omnibus test over all 130 weeks showed a GROUP*WEEKS interaction effect (p = .02), indicating differential group developments in RTW, though similarly high at week 130 in both groups with 82.4% of the IP and 77.9% of the controls having RTW (p = .22; χ2-test). A significant interaction with age led to separate analyses of the younger and older subgroups, indicating a stable pattern of superior RTW only among younger IP (week 130: 88.6% vs. 69.7%, p = .054; χ2-test). There was no group difference in relapses into increased degree of sick leave. Part-time sick leave did not predict a later stable full-time RTW. Conclusions The previously reported improvement in RTW with the newly developed workplace-oriented intervention showed a long-term stability only among younger participants.
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Affiliation(s)
| | | | - Kai Österberg
- Department of Psychology, Lund University, Box 213, SE-221 00 Lund, SWEDEN.
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Stenfors CUD, Marklund P, Magnusson Hanson LL, Theorell T, Nilsson LG. Are subjective cognitive complaints related to memory functioning in the working population? BMC Psychol 2014. [DOI: 10.1186/2050-7283-2-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
The aim was to assess long-term cognitive performance after substantial recovery from work-stress-related exhaustion, in relation to subjective cognitive complaints and return to active work. In total, 54 patients previously diagnosed with work-stress-related exhaustion participated in a neuropsychological examination ∼2 years after initial sick leave. Most participants were substantially recovered at follow-up, with only 13% still meeting the criteria for exhaustion disorder suggested by the Swedish National Board of Health and Welfare. When participants' scores on 14 neuropsychological tests were compared to a matched group of 50 controls, the former patient group showed lower performance mainly on attention tests of the reaction time type, but also slightly lower scores on visuo-spatial constructional ability. However, the former patient group performed better than controls on two memory tests and, in part, on a test of simultaneous capacity. Self-ratings of everyday cognitive problems remained significantly higher in the former patient group than among controls, but the extent of self-rated cognitive problems was generally unrelated to performance on the neuropsychological tests. No relationship between performance on these tests and the extent of work resumption was observed. In summary, persons with previous work-stress-related exhaustion showed persistent signs of a minor attention deficit, despite considerable general recovery and return to work.
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Stenfors CUD, Marklund P, Magnusson Hanson LL, Theorell T, Nilsson LG. Subjective cognitive complaints and the role of executive cognitive functioning in the working population: a case-control study. PLoS One 2013; 8:e83351. [PMID: 24386185 PMCID: PMC3873297 DOI: 10.1371/journal.pone.0083351] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 11/01/2013] [Indexed: 11/25/2022] Open
Abstract
Background Cognitive functioning is important for managing work and life in general. However, subjective cognitive complaints (SCC), involving perceived difficulties with concentration, memory, decision making, and clear thinking are common in the general and working population and can be coupled with both lowered well-being and work ability. However, the relation between SCC and cognitive functioning across the adult age-span, and in the work force, is not clear as few population-based studies have been conducted on non-elderly adults. Thus, the present study aimed to test the relation between SCC and executive cognitive functioning in a population-based sample of employees. Methods Participants were 233 employees with either high (cases) or low (controls) levels of SCC. Group differences in neuropsychological test performance on three common executive cognitive tests were analysed through a set of analyses of covariance tests, including relevant covariates. Results & Conclusions In line with the a priori hypotheses, a high level of SCC was associated with significantly poorer executive cognitive performance on all three executive cognitive tests used, compared to controls with little SCC. Additionally, symptoms of depression, chronic stress and sleeping problems were found to play a role in the relations between SCC and executive cognitive functioning. No significant associations remained after adjusting for all these factors. The current findings contribute to an increased understanding of what characterizes SCC in the work force and may be used at different levels of prevention of- and intervention for SCC and related problems with executive cognitive functioning.
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Affiliation(s)
- Cecilia U. D. Stenfors
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Stress Research Institute, Stockholm University, Stockholm, Sweden
- * E-mail: ;
| | - Petter Marklund
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | - Töres Theorell
- Stress Research Institute, Stockholm University, Stockholm, Sweden
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
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Beck J, Gerber M, Brand S, Pühse U, Holsboer-Trachsler E. Executive function performance is reduced during occupational burnout but can recover to the level of healthy controls. J Psychiatr Res 2013; 47:1824-30. [PMID: 24018104 DOI: 10.1016/j.jpsychires.2013.08.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 08/05/2013] [Accepted: 08/09/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Burnout is a work-related syndrome that comprises physical fatigue, emotional exhaustion and cognitive weariness and is considered to be a risk factor for the development of major depression. While cognitive impairments in major depression persist even after remission of mood symptoms, the role of cognitive impairments in burnout is less clear. The hypothesis tested in the present study submits that executive function performance is reduced during burnout compared to healthy subjects but can recover to normal levels. METHODS 12 male subjects (mean age 45.8 ± 6.8 years) suffering from occupational burnout took part in the study. They completed questionnaires related to burnout severity and underwent testing of executive functions twice at baseline and at follow-up 12 weeks later. Between baseline and follow-up burnout participants performed regular aerobic exercise training. Executive function performance at baseline and follow-up was compared to 12 matched healthy controls. RESULTS Executive functioning was significantly reduced during acute burnout compared to healthy controls. At follow-up, both burnout severity and executive functioning were improved. Changes in burnout severity and executive function performance were not related. CONCLUSIONS Data suggest that executive function performance is impaired during acute burnout but can recover to the level of healthy controls. This finding is at odds with the finding of persistent deficits in the same tests found in major depression even after remission of depressive mood. Results may indicate that the pathophysiological changes underlying the impaired executive functioning during burnout are less pronounced compared to those in major depression.
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Affiliation(s)
- Johannes Beck
- Psychiatric University Clinics (UPK) of the University of Basel, Switzerland.
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Stenfors CUD, Magnusson Hanson L, Oxenstierna G, Theorell T, Nilsson LG. Psychosocial working conditions and cognitive complaints among Swedish employees. PLoS One 2013; 8:e60637. [PMID: 23560101 PMCID: PMC3613346 DOI: 10.1371/journal.pone.0060637] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 03/01/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cognitive complaints involving problems with concentration, memory, decision-making and thinking are relatively common in the work force. The sensitivity of both subjective and objective cognitive functioning to common psychiatric conditions, stress levels and to cognitive load makes it plausible that psychosocial working conditions play a role in cognitive complaints. Thus, this study aimed to test the associations between psychosocial work factors and cognitive complaints in nationally representative samples of the Swedish work force. Cross-sectional (n = 9751) and prospective (n = 3644; two time points two years apart) sequential multiple regression analyses were run, adjusting for general confounders, depressive- and sleeping problems. Additional prospective analyses were run adjusting for baseline cognitive complaints. CROSS/SECTIONAL RESULTS High quantitative demands, information and communication technology (ICT) demands, under qualification and conflicts were positively associated with cognitive complaints, while social support, good resources at work and over qualification were negatively associated with cognitive complaints in all models. Skill discretion and decision authority were weakly associated with cognitive complaints. Conflicts were more strongly associated with cognitive complaints in women than in men, after adjustment for general confounders. PROSPECTIVE RESULTS Quantitative job demands, ICT demands and under qualification were positively associated with future cognitive complaints in all models, including when adjusted for baseline cognitive complaints. Decision authority was weakly positively associated with future cognitive complaints, only after adjustment for depressive- and sleeping problems respectively. Social support was negatively associated with future cognitive complaints after adjustment for general confounders and baseline cognitive complaints. Skill discretion and resources were negatively associated with future cognitive complaints after adjustment for general confounders. The associations between quantitative demands and future cognitive complaints were stronger in women. DISCUSSION/CONCLUSIONS The findings indicate that psychosocial working conditions should be taken into account when considering cognitive complaints among employees.
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