Occupational burnout and medically certified sickness absence: a population-based study of Finnish employees

OBJECTIVE: Occupational burnout is a common problem in working populations, but its association with sickness absence is poorly understood. The contribution of occupational burnout to medically certified sickness absence was examined in a population-based sample of employees. METHODS: A representative sample of 3151 Finnish employees aged 30-60 years participated in a comprehensive health study in 2000-2001, including an assessment of physician-diagnosed physical illnesses and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders based on the Composite International Diagnostic Interview. Burnout was measured with the Maslach Burnout Inventory-General Survey. Sickness absences longer than 9 days in 2000-2001 were extracted from a register of the Social Insurance Institution of Finland. RESULTS: The occurrence of medically certified sickness absence was more prevalent among employees with burnout than among those without burnout. After adjusting for sociodemographic factors and mental and physical disorders, the odds ratio of sickness absence for severe burnout was 6.9 [95% confidence interval (95% CI)=2.7-17.8] for men and 2.1 (95% CI=1.1-4.0) for women. Among employees with mental or physical disorders, severe burnout was associated with a 7.7-fold risk of sickness absence among men and with a 2.6-fold risk among women. The duration of absence was related to burnout among men with absences, for whom severe burnout accounted for 52 excess sickness absence days during the 2-year period after adjusting for sociodemographic factors, mental disorders, and physical illnesses. CONCLUSIONS: Severe burnout is associated with a substantial excess risk of medically certified sickness absence among both men and women. This association is independent of prevalent mental disorders and physical illnesses.     

Depressive symptoms and the risk of long-term sickness absence

Background The aim of this paper is to examine the impact of depressive symptoms on long-term sickness absence in a representative sample of the Danish workforce. Methods This prospective study is based on 4,747 male and female employees, participating in the Danish Work Environment Cohort Study. Depressive symptoms were measured at baseline. Data on sickness absence were obtained from a national register on social transfer payments. Onset of long-term sickness absence was followed up for 78 weeks. Results The cumulative 78 weeks incidence for the onset of long-term sickness absence was 6.5% in men and 8.9% in women. Both men and women with severe depressive symptoms (≤52 points) were at increased risk of long-term sickness absence during follow-up (men: HR = 2.69; 95% CI: 1.18, 6.12; women: HR = 2.27; 95% CI: 1.25, 4.11), after adjustment for demographic, health related, and lifestyle factors. When we divided the depressive symptom scores into quartiles, we found no significant effects with regard to long-term sickness absence. Conclusions Severe depressive symptoms, as measured with the MHI-5, increased the risk of future long-term sickness absence in the general Danish working population. However, effects were not linear, but occurred mostly only in those employees with high levels of depressive symptoms.     

Sickness absence in Swedish parents of children with Down's syndrome: relation to self-perceived health, stress and sense of coherence

Background The aims of present study were to study sickness absence among Swedish parents of children with Down’s syndrome (DS) and to compare their rates of absence with those of control parents. Sickness absence data for 165 DS parents were compared with those for 174 control parents; all data were for the period 1997–2000. Sickness absence rates were also related to parental self‐perceived health, stress and sense of coherence. Methods The self‐administrated measures of parental self‐perceived health, stress and sense of coherence were compared with the number of days of sickness absence. Results In about two‐thirds of the parents in both the study and the control group, no days of sickness absence were registered. Six of the DS parents had remarkably large numbers of days of sickness absence (more than 100 per year). None of the control parents had such high sickness absence rates. It is speculated that there is a small group (less than 5%) of parents who are more vulnerable to the birth of a child with DS. Apart from these six DS parents, sickness absence was not more frequent among the DS parents than among the control parents. DS parents stayed at home to care for their sick DS child three times more often than control parents did for their non‐disabled child. DS fathers took greater responsibility in the care of their temporarily sick child and stayed at home to care for the child even more often than control mothers did. DS parents with sickness periods experienced small deterioration in self‐perceived health, significantly higher stress and decreased sense of coherence in comparison with parents without sickness periods. Conclusions There was a great similarity in sick leave rates due to one’s own sickness between DS and control parents, but a small group of DS parents (<5%) may be more vulnerable. DS fathers stayed at home to care for their sick DS child remarkably often.     

Factors related to coping with physical and instrumental activities of daily living among people born in 1904–1923

Functional ability is affected by a number of different factors, including biological ageing, illness, and living environment. This study was concerned with the connections of functional ability with mood and cognitive capacity in elderly individuals. It forms part of a cross-sectional study which was carried out in 1988, involving two random samples of 800 non-institutionalized persons born in 1904–1913 and 1914–1923. Functional ability tests included 18 questions; eight concerned coping with physical activities of daily living (PADL) and 10 instrumental activities of daily living (IADL). Depressive symptoms and cognitive capacity were examined by tests. In addition, there was a set of questions concerning health status and socioeconomic situation. Regression models (LISREL) were used to identify factors associated with PADL and IADL activities. In the younger age group, 68% of the men and 65% of the women had no difficulty in coping with PADL activities. The figures for the older group were 58% and 37%, respectively. Difficulties were reported more frequently with IADL activities. In the older age group 17% of the men and 10% of the women coped with no difficulty. In all activities difficulties tended to increase with age, and more so among women than men. The explanatory factors that emerged from the regression models as most significant were the number of chronic illnesses, the number of depressive symptoms and cognitive capacity.     

The mental health effects of multiple work and family demands

Background Individuals who experience work stress or heavy family demands are at elevated risk of poor mental health. Yet, the cumulative effects of multiple work and family demands are not well known, particularly in men. Methods We studied the association between multiple work and family demands and sickness absence due to non-psychotic psychiatric disorders in a longitudinal study conducted among members of the French GAZEL cohort study (8,869 men, 2,671 women) over a period of 9 years (1995–2003). Work stress and family demands were measured by questionnaire. Medically certified psychiatric sickness absence data were obtained directly from the employer. Rate ratios (RRs) of sickness absence were calculated using Poisson regression models, adjusting for age, marital status, social support, stressful life events, alcohol consumption, body mass and depressive symptoms at baseline. Results Participants simultaneously exposed to high levels of work and family demands (≥2 work stress factors and ≥4 dependents) had significantly higher rates of sickness absence due to non-psychotic psychiatric disorders than participants with lower levels of demands (compared to participants exposed to 0–1 work stress factors and with 1–3 dependents, age-adjusted rate ratios were 2.37 (95% CI 1.02–5.52) in men and 6.36 (95% CI 3.38–11.94) in women. After adjusting for baseline socio-demographic, behavioral and health characteristics, these RRs were respectively reduced to 1.82 (95% CI 0.86–3.87) in men, 5.04 (95% CI 2.84–8.90) in women. The effect of multiple work and family demands was strongest for sickness absence due to depression: age-adjusted RRs among participants with the highest level of work and family demands were 4.70 (1.96–11.24) in men, 8.57 (4.26–17.22) in women; fully adjusted RRs: 3.55 (95% CI 1.62–7.77) in men, 6.58 (95%CI 3.46–12.50) in women. Conclusions Men and women simultaneously exposed to high levels of work stress and family demands are at high risk of experiencing mental health problems, particularly depression.     

Stress and behavioral risk among young expectant couples

Few studies have explored stress and coping among adolescents who are expecting a baby. In particular, young men's experiences during pregnancy have largely been ignored, despite the fact that a young man's experiences and behaviors carry implications for his own, his partner's and his child's health. This study examined the association between maternal and paternal experiences of stress during pregnancy with one's own and one's partner's health behaviors and depressive symptoms among 294 young expectant couples in the U.S. Multilevel modeling showed that one's own experiences of stress were associated with more unhealthy behaviors and more depressive symptoms among both expectant mothers and fathers. Paternal experiences of stress were predictive of more maternal conduct problems, while maternal experiences of stress were predictive of more paternal depressive symptoms and less paternal substance use. These findings highlight the importance of social relationships in affecting health behaviors and mental health among expectant adolescents.     

Understanding perceptions underlying the self-reported stress among parents of adolescents with autism spectrum disorder: Considerations for supporting families

BackgroundParents raising adolescents with autism spectrum disorder (ASD) often report higher stress than other parents. The influence of parents’ internal, or cognitive, experiences (i.e., their own perceptions) on this elevated stress has yet to be explored. Addressing this gap may reveal opportunities for enhancing support for families by elucidating malleable targets for reducing parents’ self-reported stress and/or informing family-focused intervention. The Double ABCX Model of Family Adaptation is a framework for understanding how perceptions, social support, and personal resources (i.e., coping) may affect stress.MethodsWe examined parents’ perceptions about ASD, perceived support, and coping among 214 parents of adolescents with ASD. Regression analyses were used to explore whether these factors were associated with parenting stress among those raising adolescents with ASD. Moderation effects of positive coping on the relationship between parent perceptions and parenting stress were also explored.ResultsParent perceptions about within family support, the extent of ASD symptom predictability, and treatment being able to ‘control’ ASD were related to parenting stress. However, positive coping did not moderate the relationship between these perceptions and parenting stress.ConclusionsStudy findings emphasize significant associations between specific parental perceptions and the self-reported stress among families of adolescents with ASD. Particularly important to parenting stress were how much parents’ perceived adequate support within the family, that treatment was useful for controlling their adolescent’s ASD, and that their adolescent’s symptoms were predictable. These findings suggest that the way parents think about their adolescents’ ASD and the adequacy of the support within their own families are associated with parenting stress, and therefore may serve as treatment targets for positively affecting whole family outcomes, as well as foundations for additional research.     

Case series: mental health needs and perspectives of rural children reared by parents who abuse methamphetamine

OBJECTIVE: This case-based, mixed-methods study was undertaken to understand the perspectives and mental health needs of rural children exposed to parental methamphetamine abuse. METHOD: Participants were 23 children involved with a state child protective agency because of parental methamphetamine abuse. A semistructured interview provided information on children's perspectives of their families. Information on children's mental health needs was obtained from the Child Behavior Checklist and Trauma Symptom Checklist. Case records and caseworker reports provided information on children's family experiences. RESULTS: Children described emotional pain; few social resources for coping with emotions, problem solving, or talking about their experiences; and avoidant or passive coping skills. Sixty-five percent of children evidenced significant dissociative or posttraumatic symptoms on standardized assessments; 57% had other significant emotional and behavioral problems. Challenges to understanding children's perspectives included children's perceptions that talking about methamphetamine abuse was taboo and underreporting of significant symptoms on the Trauma Symptom Checklist. CONCLUSIONS: The high rate of mental health problems suggests the need for nontraditional strategies for services delivery in rural areas that are targeted toward these vulnerable children. Early identification and treatment of mental health problems should be a priority. Clinicians should be alert to the complexities in assessing children's mental health needs.     

The relationship between past traumatic experience and sickness absence

BACKGROUND: Past traumatic experiences have been reported to lower stress tolerance, thereby increasing job strain. However, the relationship between past traumatic experiences and employee sickness absence is poorly understood. AIMS: This study explores the relationship between sickness absence and past traumatic experience with regard to the amount of time lapsed after the experience, job strain and other mental health states such as depression and anxiety. METHODS: A total of 3238 workers were assessed for levels of traumatic stress, depressive status, anxiety and job stress. RESULTS: Odds ratios of the presence of traumatic experiences to sickness absence, adjusted for sex, age and depressive and anxiety states, were presented according to the length of time that had passed since the traumatic events. The odds ratio in the 0-1 Years Group was 1.75 (p < 0.05), and the odds ratio for the 19+ Years Group was 1.46 (p < 0.1). CONCLUSIONS: Past traumatic events are related to sickness absence. Sickness absence resulting from a past traumatic experience is important with respect to industrial health.     

Family burden,child disability,and the adjustment of mothers caring for children with epilepsy: Role of social support and coping

PurposeThis study was designed to contribute to the existing research on the coping behaviors, social support, and mental health outcomes in parents of children with epilepsy in the United States.MethodsParticipants included 152, predominantly Caucasian (89.5%), married (78.9%) women (95.4%). Via a web-based interface, mothers completed questionnaires assessing the impact of their child's disability on their family (i.e., severity of their child's disability, family burden, and personal stress), social resources (i.e., perceived social support), coping (i.e., emotion-focused and social support seeking), and adjustment (i.e., depression and anxiety).ResultsAfter controlling for demographic variables, mediational analysis revealed that mothers' perceptions of the severity of their child's disability were associated with decreased perceived social support, which was then related to higher reported levels of depression and anxiety. Similarly, low levels of perceived social support partially mediated the relation between family burden and depression, anxiety, and stress. Finally, mothers' perceptions of the severity of their children's disability and family burden were unrelated to their reports of emotion-focused or social support seeking coping. However, their use of emotion-focused and social support seeking behaviors was related to lower levels of depression.ConclusionLow levels of perceived social support may help to explain the mechanisms underlying the relation between mothers' perceptions of the severity of their child's disability and family burden on their mental health adjustment, such as depression and anxiety.     

Attitudes of nursing staff towards co-workers returning from psychiatric and physical illnesses

BACKGROUND: Co-worker support, or lack of it, plays an important role in the contribution of workplace pressure to psychiatric illness and rehabilitation after sickness. AIMS: To develop and validate a measure to compare attitudes towards co-workers with different illnesses to identify specific aspects of colleagues' attitudes which may hinder the reintegration in the workplace after sickness absence of individuals with common psychiatric conditions. METHOD: A measure of co-worker behavioural concern was developed and validated using focus groups and a pilot study to determine questionnaire items. This was followed by a cross-sectional survey of 532 nursing staff within a UK hospital assessing attitudes to vignettes of a co-worker with different embedded diagnoses. RESULTS: A measure of attitudes to co-workers was developed and validated. In the survey of nurses this revealed that attitudes were significantly more negative towards co-workers returning after psychiatric illnesses than to those with diabetes. Those with alcohol problems were held in particularly low esteem. CONCLUSIONS: Psychiatric illnesses are stigmatised compared with physical illnesses, with the degree of behavioural blame evidently important. Co-worker reliability, predictability and coping were more important issues than particular work-related skills and could be incorporated into return-to-work plans.     

Determinants of beliefs about illness: A study of parents of children with diabetes, asthma, epilepsy, and no chronic illness

Social psychological models of health care behaviour frequently take as their starting point perception of the illness. This paper seeks to examine factors that may influence these perceptions. Beliefs about the seriousness of eleven childhood illnesses are compared in four groups of parents. Significant differences were evident between the groups of parents depending upon their experiences with illness. For three conditions (diabetes, asthma and epilepsy) the lowest rating of seriousness was made by parents with a child with that condition. For parents of children with diabetes, having a relative with diabetes in good health was associated with a perception of the illness as significantly less serious than those with a relative in average or poor health, or those with no relatives with diabetes. These results are interpreted within an information processing model. Implications of the findings for social psychological models of health care behaviour are discussed.     

Video interaction guidance offered to mothers with postnatal depression: Experiences from a pilot study

In the period January–August 2003, a pilot study took place connected to a research project where video interaction guidance with postnatal depressed mothers was a central part. We wanted to gain some experiences with video interaction guidance with focus on the baby. The data were collected through interviews and video recordings and analysed in a phenomenological perspective. In short, the experiences from the guidance's with the six mothers can be described as follows: the mothers experienced their own coping, the mothers engaged in mutual dialogue with their babies and the mothers suffering was recognized. Our hypothesis is that the pictures on the TV screen are especially powerful to bring forth a change in the mothers’ self-image.     

Depression in older nursing home residents: the influence of nursing home environmental stressors, coping, and acceptance of group and individual therapy

Based on in-depth interviews with 65 older nursing home residents, this study examined the residents' own understanding and perceptions of depressive symptoms, causes of their depression, their self-reported coping strategies, and their preferences for acceptable depression interventions. About half (n = 32) of all interviewees stated that they were either feeling depressed or experiencing negative affects. The major themes related to the causes of their depression were loss of independence, freedom and continuity with their past life; feelings of social isolation and loneliness; lack of privacy and frustration at the inconvenience of having a roommate and sharing a bathroom; loss of autonomy due to the institutional regimen and regulations; ambivalence toward cognitively impaired residents; ever-present death and grief; staff turnover and shortage; and stale programming and lack of meaningful in-house activities. Self-reported coping mechanisms included religion and stoicism, a sense of reality, positive attitude and family support. In regard to depression treatment, the interviewees appeared to prefer nursing home programs that reduce their isolation over group or individual psychotherapy.     

Searching for existential security: A prospective qualitative study on the influence of mindfulness therapy on experienced stress and coping strategies among patients with somatoform disorders

ObjectiveThe aim was to explore how mindfulness group therapy for somatoform disorders influenced the patients' stress experiences, coping strategies and contextual psychosocial processes.MethodsA longitudinal pre- and post-treatment design, using 22 semi-structured individual pre- and post-treatment interviews. Data-analysis was based on a thematic methodology.ResultsPre-treatment patients were struggling in an existential crisis, feeling existentially insecure about their social identity, the causes, consequences and management of their illness; experiencing difficulties identifying and expressing stress-related cognitions, emotions and feelings, and low bodily and emotional self-contact; often leading to avoidant coping, making these individuals highly stress-vulnerable. Post-treatment, the overall change was conceptualized as increased existential security, defined by patients being more self-confident; more clarified with their social identity, the nature, management and future prospects of their illness; generally using more flexible coping strategies to reduce their daily stress experiences. Four related subthemes were identified contributing to increased existential security: 1) more secure illness perceptions — feeling existentially recognized as “really” ill, 2) enhanced relaxation ability — using mindfulness techniques, 3) increased awareness — connecting differently to mind and body 4) improved ability to identify and express needs and feelings of distress — more active communicating. Patients suggested that mindfulness therapy could be expanded with more time for group-discussions followed by additional individual therapy.ConclusionGenerally, treatment positively influenced the patients' illness perceptions, stress-experiences, body- and self-awareness, coping strategies, self-image, social identity and social functioning. However, patients identified potentials for treatment improvements, and they needed further treatment to fully recover.     

Perceptions of the process of care among caregivers and care recipients in dementia care networks

The Dementia Care Networks Study investigated 4 community-based, not-for-profit dementia care networks in Ontario, Canada. Investigators examined whether sociodemographic and health characteristics, type of support network, and amount of service use among care recipients and caregivers (n = 267 dyads) were associated with experiences with care processes. The process-of-care constructs were: family physicians' awareness of services; experiences with health care workers, and assessment and placement activities. The findings highlighted that family physicians' understanding of dementia and their ability to work with the dyad to become aware of and accept services, was an important component in the dyad's satisfaction. If caregivers received home support and the care recipients received emotional support from their social support network, they were more likely to be satisfied with their experiences with health care workers. In summary, increased awareness and provision of services were associated with more positive perceptions of network effectiveness.     

Linking learning and health: a pilot study of medical students' perceptions of the academic impact of various health issues.

OBJECTIVE: To assess medical students' experience with a wide variety of health concerns and their perceptions of the impact of these health concerns on their academic performance. METHODS: The National College Health Assessment (NCHA) was administered to all students enrolled at a single medical school during the spring term of 2005. RESULTS: Students reported the greatest perceived negative academic impact related to experiencing interpersonal concerns (concerns about troubled friends or family members, death of a friend or family member, and relationship difficulty) and mental health concerns (depression/anxiety/seasonal affective disorder and stress). A total of 315 students participated (48% response rate). CONCLUSION: Medical students perceive their experiences with social and psychological concerns as negatively influential to their academic well-being. Strategies that assist students in coping with these issues support the learning mission of the academic medical center.     

Social support buffers young men's resilient coping to psychological distress

Aim

Social support and resilient coping can aid mental health. The aim of this study was to examine age effects of social support on men's resilient coping for psychological distress.

Methods

The sample consisted of 434 help-seeking Canadian men who completed standardized measures. Regression analyses tested a moderated moderation model, controlling for COVID-19 pandemic impact.

Results

Greater resilient coping was associated with lower psychological distress and this relationship was moderated by social support. Higher levels of social support had a significant positive effect on men's resilient coping for psychological distress. Findings indicated that younger men (18–24 years) were most positively buffered by social support.

Conclusions

Social support appears to be particularly important for young men's coping response to psychological distress. This is an important finding in the context of the COVID-19 pandemic, where social support networks have been challenged. Community-based and clinical programs and initiatives that proactively target young men's development of social connections and robust supportive networks, while bolstering their individual resilient coping skills, are likely to provide protections from psychological distress.     

Longitudinal outcome and recovery of social problems after pediatric traumatic brain injury (TBI): Contribution of brain insult and family environment

Pediatric traumatic brain injury (TBI) can result in a range of social impairments, however longitudinal recovery is not well characterized, and clinicians are poorly equipped to identify children at risk for persisting difficulties. Using a longitudinal prospective design, this study aimed to evaluate the contribution of injury and non-injury related risk and resilience factors to longitudinal outcome and recovery of social problems from 12- to 24-months post-TBI. 78 children with TBI (injury age: 5.0–15.0 years) and 40 age and gender-matched typically developing (TD) children underwent magnetic resonance imaging including a susceptibility-weighted imaging (SWI) sequence 2–8 weeks post-injury (M = 39.25, SD = 27.64 days). At 12 and 24-months post- injury, parents completed questionnaires rating their child’s social functioning, and environmental factors including socioeconomic status, caregiver mental health and family functioning. Results revealed that longitudinal recovery profiles differed as a function of injury severity, such that among children with severe TBI, social problems significantly increased from 12- to 24-months post-injury, and were found to be significantly worse than TD controls and children with mild and moderate TBI. In contrast, children with mild and moderate injuries showed few problems at 12-months post-injury and little change over time. Pre-injury environment and SWI did not significantly contribute to outcome at 24-months, however concurrent caregiver mental health and family functioning explained a large and significant proportion of variance in these outcomes. Overall, this study shows that longitudinal recovery profiles differ as a function of injury severity, with evidence for late-emerging social problems among children with severe TBI. Poorer long-term social outcomes were associated with family dysfunction and poorer caregiver mental health at 24-months post injury, suggesting that efforts to optimize the child’s environment and bolster family coping resources may enhance recovery of social problems following pediatric TBI.     

The association of adverse childhood experiences with mid-life depressive symptoms and quality of life among incarcerated males: exploring multiple mediation

Objectives: To explore the association of experiencing death, trauma, and abuse during childhood with depressive symptoms and quality of life at mid-life among incarcerated men and to understand how current social support and coping strategies mediate the impact of childhood trauma histories on mental health.

Methods: Study participants were 192 male inmates in a maximum security prison. Participants completed measures of adverse childhood experiences related to death, trauma, and abuse, and depressive symptoms and quality of life. Data were analyzed using multiple mediation modeling.

Results: Men who reported having experienced adverse childhood experiences reported more depressive symptoms and lower quality of life than their counterparts. The results showed that in models both unadjusted and adjusted for age, race, education, number of years served, and whether the inmate had a life sentence, the association between adverse childhood experiences and quality of life were partially explained by the total of the indirect effects (point estimate = ?.5052; CI_.95 = ?1.0364, ?.0429 and point estimate = ?.7792; CI_.95 = ?1.6369, ?.0381), primarily via social support. However, the associations between adverse childhood experiences and depressive symptoms were not explained by social support and coping.

Conclusion: Adverse childhood experiences are associated with deleterious mental health effects in later life. Social support and coping partially mediate the association between adverse childhood experiences and quality of life. The high prevalence of childhood trauma among aging prison inmates warrants attention to increasing social support mechanisms to improve mental health.