期刊论文详细信息
BMC Psychiatry
Prevalence and course of somatic symptoms in patients with stress-related exhaustion: does sex or age matter
Ingibjörg H Jonsdottir2  Gunnar Ahlborg2  Kristina Glise1 
[1] Occupational and Environmental Medicine at the Department of Public Health and Community Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden;The Institute of Stress Medicine, Sahlgrenska Academy at the University of Gothenburg, Carl Skottsbergs gata 22B, Göteborg SE-413 19, Sweden
关键词: Somatic symptoms;    Age;    Sex;    Burnout;    Exhaustion;    Stress;   
Others  :  1123630
DOI  :  10.1186/1471-244X-14-118
 received in 2013-06-13, accepted in 2014-04-14,  发布年份 2014
PDF
【 摘 要 】

Background

Both mental and somatic symptoms are commonly reported in patients with stress-related problems. We have explored the prevalence of somatic symptoms in patients seeking medical care for stress-related mental health problems and followed the course of illnes alongside with that the patients receive multimodal treatment.

Method

This study comprises data from 228 patients (69% women, mean age 43 years) who fulfilled the criteria for Exhaustion Disorder (ED). Somatic symptoms were assessed at baseline and after 3, 6, 12 and 18 months using the one-page questionnaire Primary Care Evaluation of Mental Disorders. Prevalence of different symptoms was compared between men and women and patients, over and below 40 years of age, and possible predictors of recovery were explored.

Results

Tiredness and low energy are the core symptom reported by the patients. Almost all (98%) reported at least one somatic symptom and 45% reported six symptoms or more, which was similar for men and women. Nausea, gas or indigestion are the most common symptoms (67%) followed by headaches (65%) and dizziness (57%). The number of symptoms reported was significantly related to the severity of mental health problems. The only difference between the sexes was that “chest pain” and “pain or problems during sexual intercourse” were more common among males. Patients over forty more often reported “pain in arms, legs or joints, knees, hips” and this was also the only symptom that did not significantly decline during treatment. Neither sex, age, symptom duration before seeking medical care, education or any other predictor tested was shown to predict recovery in patients reporting six symptoms or more.

Conclusion

A heavy burden of somatic symptoms was generally seen in most patients with stress-related exhaustion. Somatic symptoms are equally common in males and females and in younger and older patients. The somatic symptoms seem to be mostly stress-related since all symptoms, except musculoskeletal pain, reduce with individualised treatment designed for stress-related mental problems. This study brings to attention the complicated burden of both somatic and mental symptoms in patients with stress-related exhaustion, raising several clinical implications of interest to discuss.

【 授权许可】

   
2014 Glise et al.; licensee BioMed Central Ltd.

【 预 览 】
附件列表
Files Size Format View
20150216040832650.pdf 299KB PDF download
Figure 2. 95KB Image download
Figure 1. 23KB Image download
【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】
  • [1]Nixon A, Mazzola J, Bauer J, Krueger J, Spector P: Can work make you sick? A meta-analysis of the relationship between job stressors and physical symptoms. Work Sress 2011, 25(1):1-22.
  • [2]Nieuwenhuijsen K, Bruinvels D, Frings-Dresen M: Psychosocial work environment and stress-related disorders, a systematic review. Occup Med (Oxford, England) 2010, 60(4):277-286.
  • [3]Maslach C, Schaufeli WB, Leiter MP: Job burnout. Annu Rev Psychol 2001, 52:397-422.
  • [4]Schaufeli WB, Bakker AB, Hoogduin K, Schaap C, Kladler A: On the clinical validity of the Maslach burnout inventory and the burnout measure. Psychol Health 2001, 16(5):565-582.
  • [5]Roelofs J, Verbraak M, Keijsers GP, de Bruin MBN, Schmidt JM: Psychometric properties of a Dutch version of the Maslach Burnout Inventory General Survey (MBI-DV) in individuals with and without clinical burnout. Stress Health 2005, 21:17-25.
  • [6]Lundgren-Nilsson A, Jonsdottir IH, Pallant J, Ahlborg G Jr: Internal construct validity of the Shirom-Melamed Burnout Questionnaire (SMBQ). BMC Public Health 2012, 12(1):1. BioMed Central Full Text
  • [7]Jonsdottir IH, Hagg DA, Glise K, Ekman R: Monocyte chemotactic protein-1 (MCP-1) and growth factors called into question as markers of prolonged psychosocial stress. PLoS One 2009, 4(11):e7659.
  • [8]Glise K, Ahlborg G Jr, Jonsdottir IH: Course of mental symptoms in patients with stress-related exhaustion: Does sex or age make a difference? BMC Psychiatr 2012, 12(1):18. BioMed Central Full Text
  • [9]Hasselberg K, Jonsdottir IH, Ellbin S, Skagert K: Self-reported stressors among patients with Exhaustion Disorder: an exploratory study of patient records. BMC Psychiatr 2014, 14(1):66. BioMed Central Full Text
  • [10]Osterberg K, Karlson B, Hansen AM: Cognitive performance in patients with burnout, in relation to diurnal salivary cortisol. Stress (Amsterdam, Netherlands) 2009, 12(1):70-81.
  • [11]Stenlund T, Ahlgren C, Lindahl B, Burell G, Steinholtz K, Edlund C, Nilsson L, Knutsson A, Birgander LS: Cognitively oriented behavioral rehabilitation in combination with Qigong for patients on long-term sick leave because of burnout: REST-a randomized clinical trial. Int J Behav Med 2009, 16(3):294-303.
  • [12]Karlson B, Jonsson P, Palsson B, Abjornsson G, Malmberg B, Larsson B, Osterberg K: Return to work after a workplace-oriented intervention for patients on sick-leave for burnout–a prospective controlled study. BMC Public Health 2010, 10:301. BioMed Central Full Text
  • [13]Rydmark I, Wahlberg K, Ghatan PH, Modell S, Nygren A, Ingvar M, Asberg M, Heilig M: Neuroendocrine, cognitive and structural imaging characteristics of women on longterm sickleave with job stress-induced depression. Biol Psychiatry 2006, 60(8):867-873.
  • [14]Gerber PD, Barrett JE, Barrett JA, Oxman TE, Manheimer E, Smith R, Whiting RD: The relationship of presenting physical complaints to depressive symptoms in primary care patients. J Gen Intern Med 1992, 7(2):170-173.
  • [15]Kroenke K, Jackson JL, Chamberlin J: Depressive and anxiety disorders in patients presenting with physical complaints: clinical predictors and outcome. Am J Med 1997, 103(5):339-347.
  • [16]Kroenke K, Spitzer RL, Williams JB, Linzer M, Hahn SR, de Gruy FV 3rd, Brody D: Physical symptoms in primary care. Predictors of psychiatric disorders and functional impairment. Arch Fam Med 1994, 3(9):774-779.
  • [17]Lipowski ZJ: Somatization: the concept and its clinical application. Am J Psychiatry 1988, 145(11):1358-1368.
  • [18]Aaseth K, Grande RB, Leiknes KA, Benth JS, Lundqvist C, Russell MB: Personality traits and psychological distress in persons with chronic tension-type headache. The Akershus study of chronic headache. Acta Neurol Scand 2011, 124(6):375-382.
  • [19]Cathcart S, Winefield AH, Lushington K, Rolan P: Stress and tension-type headache mechanisms. Cephalalgia 2010, 30(10):1250-1267.
  • [20]Surdea-Blaga T, Baban A, Dumitrascu DL: Psychosocial determinants of irritable bowel syndrome. World J Gastroenterol 2012, 18(7):616-626.
  • [21]Konturek PC, Brzozowski T, Konturek SJ: Stress and the gut: pathophysiology, clinical consequences, diagnostic approach and treatment options. J Physiol Pharmacol 2011, 62(6):591-599.
  • [22]Shoss MK, Shoss BL: Check-up time: a closer look at physical symptoms in occupational health research. Stress Health 2012, 28(3):193-201.
  • [23]Yap EC: Myofascial pain-an overview. Ann Acad Med Singapore 2007, 36(1):43-48.
  • [24]Honkonen T, Ahola K, Pertovaara M, Isometsa E, Kalimo R, Nykyri E, Aromaa A, Lonnqvist J: The association between burnout and physical illness in the general population–results from the Finnish Health 2000 Study. J Psychosom Res 2006, 61(1):59-66.
  • [25]Soares JJ, Grossi G, Sundin O: Burnout among women: associations with demographic/socio-economic, work, life-style and health factors. Arch Womens Ment Health 2007, 10(2):61-71.
  • [26]Peterson U, Demerouti E, Bergstrom G, Samuelsson M, Asberg M, Nygren A: Burnout and physical and mental health among Swedish healthcare workers. J Adv Nurs 2008, 62(1):84-95.
  • [27]van der Doef M, Mbazzi FB, Verhoeven C: Job conditions, job satisfaction, somatic complaints and burnout among East African nurses. J Clin Nurs 2011, 21(11–12):1763-1775.
  • [28]Ihlebaek C, Eriksen HR, Ursin H: Prevalence of subjective health complaints (SHC) in Norway. Scand J Public Health 2002, 30(1):20-29.
  • [29]Kroenke K, Spitzer RL: Gender differences in the reporting of physical and somatoform symptoms. Psychosom Med 1998, 60(2):150-155.
  • [30]Weissman M: Depression. Ann Epidemiol 2009, 19(4):264-267.
  • [31]Hopcroft R, Burr-Bradley D: The sex difference in depression across 29 countries. Social Forces 2007, 85(4):1484-1507.
  • [32]Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen HU, Kendler KS: Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994, 51(1):8-19.
  • [33]Norlund S, Reuterwall C, Hoog J, Lindahl B, Janlert U, Slunga BL: Burnout, working conditions and gender - results from the northern Sweden MONICA Study. BMC Public Health 2010, 10(1):326. BioMed Central Full Text
  • [34]Lindblom KM, Linton SJ, Fedeli C, Bryngelsson IL: Burnout in the working population: relations to psychosocial work factors. Int J Behav Med 2006, 13(1):51-59.
  • [35]Ahola K, Honkonen T, Isometsa E, Kalimo R, Nykyri E, Koskinen S, Aromaa A, Lonnqvist J: Burnout in the general population. Results from the Finnish Health 2000 Study. Soc Psychiatry Psychiatr Epidemiol 2006, 41(1):11-17.
  • [36]Haug TT, Mykletun A, Dahl AA: The Association Between Anxiety, Depression, and Somatic Symptoms in a Large Population: The HUNT-II Study. Psychosom Med 2004, 66(6):845-851.
  • [37]Spitzer RL, Williams JB, Kroenke K, Linzer M, deGruy FV 3rd, Hahn SR, Brody D, Johnson JG: Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. JAMA 1994, 272(22):1749-1756.
  • [38]Griffith JP, Zarrouf FA: A systematic review of chronic fatigue syndrome: don’t assume it’s depression. Prim Care Companion J Clin Psychiatry 2008, 10(2):120-128.
  • [39]Nampiaparampil DE, Shmerling RH: A review of fibromyalgia. Am J Manag Care 2004, 10(11 Pt 1):794-800.
  • [40]Melamed S, Kushnir T, Shirom A: Burnout and risk factors for cardiovascular diseases. Behav Med 1992, 18(2):53-60.
  • [41]Grossi G, Perski A, Evengard B, Blomkvist V, Orth-Gomer K: Physiological correlates of burnout among women. J Psychosom Res 2003, 55(4):309-316.
  • [42]Stenlund T, Ahlgren C, Lindahl B, Burell G, Knutsson A, Stegmayr B, Birgander LS: Patients with burnout in relation to gender and a general population. Scand J Public Health 2007, 35(5):516-523.
  • [43]Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand 1983, 67(6):361-370.
  • [44]Kroenke K: Patients presenting with somatic complaints: Epidemiology, psychiatric co-morbidity and management. Int J Methods Psychiatr Res 2003, 12(1):34-43.
  • [45]Kroenke K, Price RK: Symptoms in the community. Prevalence, classification, and psychiatric comorbidity. Arch Intern Med 1993, 153(21):2474-2480.
  • [46]Al-Windi A: Determinants of complaint symptoms in a Swedish health care practice–results of a questionnaire survey. J Psychosom Res 2004, 57(3):307-316.
  • [47]Fagring AJ, Kjellgren KI, Rosengren A, Lissner L, Manhem K, Welin C: Depression, anxiety, stress, social interaction and health-related quality of life in men and women with unexplained chest pain. BMC Public Health 2008, 8:165. BioMed Central Full Text
  • [48]Kivimaki M, Leino-Arjas P, Luukkonen R, Riihimaki H, Vahtera J, Kirjonen J: Work stress and risk of cardiovascular mortality: prospective cohort study of industrial employees. BMJ (Clinical research ed) 2002, 325(7369):857.
  • [49]Kroenke K, Arrington ME, Mangelsdorff AD: The prevalence of symptoms in medical outpatients and the adequacy of therapy. Arch Intern Med 1990, 150(8):1685-1689.
  • [50]Gureje O, Simon G: The natural history of somatization in primary care. Psychol Med 1999, 29:669-676.
  • [51]Lambeek LC, van Mechelen W, Knol DL, Loisel P, Anema JR: Randomised controlled trial of integrated care to reduce disability from chronic low back pain in working and private life. BMJ 2010, 340:c1035.
  • [52]Blair MJ, Robinson RL, Katon W, Kroenke K: Depression and pain comorbidity: a literature review. Arch Intern Med 2003, 163(20):2433-2445.
  • [53]Simon GE, Katon W, Rutter C, VonKorff M, Lin E, Robinson P, Bush T, Walker EA, Ludman E, Russo J: Impact of improved depression treatment in primary care on daily functioning and disability. Psychol Med 1998, 28(3):693-701.
  • [54]Creed F, Barsky A: A systematic review of the epidemiology of somatisation disorder and hypochondriasis. J Psychosom Res 2004, 56(4):391-408.
  文献评价指标  
  下载次数:14次 浏览次数:15次