Do Healthy People Worry? Modern Health Worries,Subjective Health Complaints,Perceived Health,and Health Care Utilization

Background  

Modern health worries (MHW) are concerns related to modern or technological features of daily life (e.g., air pollution, x-rays, food additives, etc.), and have been associated with subjective health complaints (SHC) and health care use.     

Subjective Health Complaints and Self-Rated Health: Are Expectancies More Important Than Socioeconomic Status and Workload?

Background

The associations between socioeconomic status (SES), physical and psychosocial workload and health are well documented. According to The Cognitive Activation Theory of Stress (CATS), learned response outcome expectancies (coping, helplessness, and hopelessness) are also important contributors to health. This is in part as independent factors for health, but coping may also function as a buffer against the impact different demands have on health.

Purpose

The purpose of this study was to investigate the relative effect of SES (as measured by level of education), physical workload, and response outcome expectancies on subjective health complaints (SHC) and self-rated health, and if response outcome expectancies mediate the effects of education and physical workload on SHC and self-rated health.

Methods

A survey was carried out among 1,746 Norwegian municipal employees (mean age 44.2, 81 % females). Structural Equation Models with SHC and self-rated health as outcomes were conducted. Education, physical workload, and response outcome expectancies, were the independent 28 variables in the model.

Results

Helplessness/hopelessness had a stronger direct effect on self-rated health and SHC than education and physical workload, for both men and women. Helplessness/hopelessness fully mediated the effect of physical workload on SHC for men (0.121), and mediated 30 % of a total effect of 0.247 for women. For women, education had a small but significant indirect effect through helplessness/hopelessness on self-rated health (0.040) and SHC (?0.040), but no direct effects were found. For men, there was no effect of education on SHC, and only a direct effect on self-rated health (0.134).

Conclusions

The results indicated that helplessness/hopelessness is more important for SHC and health than well-established measures on SES such as years of education and perceived physical workload in this sample. Helplessness/hopelessness seems to function as a mechanism between physical workload and health.     

Modern Health Worries, Somatosensory Amplification and Subjective Symptoms: A Longitudinal Study

Background

Modern health worries (MHWs; i.e., concerns about possibly harmful features of modern life) have been associated with somatic symptoms and somatosensory amplification in previous cross-sectional studies. Causal relationship among these variables is yet to be discovered.

Purpose

The study investigates the temporal association among subjective symptoms, somatosensory amplification (SSA), and modern health worries (MHWs).

Method

Baseline and follow-up questionnaires (somatic symptoms—PHQ-15, somatosensory amplification scale—SSAS, modern health worries scale—MHW, PANAS negative affect scale—NA) were completed by 366 undergraduate students in a 2-month longitudinal study.

Results

MHWs were predicted by baseline MHWs (β?=?0.721, p?<?0.001) and by somatic symptoms (β?=?0.084, p?<?0.05). Somatic symptoms were predicted by baseline symptoms (β?=?0.610, p?<?0.001), NA (β?=?0.104, p?<?0.05), and SSAS scores (β?=?0.089, p?<?0.05). The only predictor of SSA was baseline SSAS score (β?=?0.628, p?<?0.001).

Conclusion

Based on the results, a linear model (proneness to somatosensory amplification leads to subjective symptoms which lead to MHWs) was proposed, where MHWs serve as explanations of physical symptoms or as possible environmental threats to avoid.     

Disagreement in doctor's and patient's rating about medically unexplained symptoms and health care use

Background

Medically unexplained (somatoform) symptoms (MUS) are highly prevalent in primary care. It remains unclear to what extent patients and their general practitioners (GPs) agree upon the etiology of physical symptoms as well as on the number of visits to the GP.

Purpose

The purpose of this study is to determine patient–physician agreement on reported symptoms.

Method

A sample of 103 persons provided information on MUS and health care utilization (HCU) during the previous 12 months. The persons' GPs (n?=?103) were asked for the same information. By determining patient–physician agreement on reported symptoms, the sample was subdivided into a concordance group (high agreement: Pt?=?GP) and two discordance groups (substantial disagreement: Pt?>?GP, Pt?<?GP).

Results

Patients and their GPs showed substantial disagreement concerning physical symptom reports for the prior 12 months. On means, patients named 3.26 (SD?=?3.23; range 0–21) physical complaints of which 71.6% were considered to be medically unexplained (MUS), whereas GPs only determined 1.77 (SD?=?1.94; range 0–11) symptoms of which 57.5% were MUS. Substantial patient–physician agreement regarding the number of reported MUS was detected in 29.1% of the cases (Pt?=?GP). Patients of all groups underestimated their HCU.

Conclusion

Since patients' and GPs' reports differ substantially concerning the etiology of symptoms and concerning HCU, both sources of data gathering should be treated carefully in primary care research.     

Psychometric Properties and Normative Data for a Swedish Version of the Modern Health Worries Scale

Purpose

The modern health worries (MHW) scale was developed to assess individuals’ worries about aspects of modernity and technology affecting personal health. The aim of this study was to psychometrically evaluate a Swedish version of the MHW scale and to provide Swedish normative data.

Method

Data were collected as part of the Västerbotten Environmental Health Study, which has a random sample of 3406 Swedish adults (18–79 years).

Results

The Swedish version of the MHW scale showed excellent internal consistency and satisfactory convergent validity. A four-factor structure consistent with the original version was confirmed. The model showed invariance across age and sex. A slightly positively skewed and platykurtic distribution was found. Normative data for the general population and for combinations of specific age groups (young, middle aged, and elderly) and sex are presented.

Conclusion

The psychometric properties of the Swedish version of the MHW scale suggest that use of this instrument is appropriate for assessing worries about modernity in Swedish-speaking and similar populations. The scale now has the advantage of good normative data being available. MHW may hold importance for understanding and predicting the development of functional disorders, such as idiopathic environmental intolerance and other medically unexplained conditions.

     

Factors Related to Non-recovery from Whiplash. The Nord-Trøndelag Health Study (HUNT)

Background

Whiplash injuries show a variable prognosis which is difficult to predict. Most individuals experiencing whiplash injuries rapidly recover but a significant proportion develop chronic symptoms and ongoing disability.

Purpose

By employing longitudinal data, we investigated how psychological and physical symptoms, self-rated health, use of health services and medications, health behavior and demographic factors predict recovery from whiplash.

Method

Data from two waves of a large, Norwegian, population-based study (The Nord-Trøndelag Health Study: HUNT2 and HUNT3) were used. Individuals reporting whiplash in HUNT2 (baseline) were identified in HUNT3 11 years later. The characteristics of individuals still suffering from whiplash in HUNT3 were compared with the characteristics of individuals who had recovered using Pearson’s chi-squared test, independent sample t-tests and logistic regression.

Results

At follow-up, 31.6 % of those reporting whiplash at baseline had not recovered. These individuals (n?=?199) reported worse health at baseline than recovered individuals (n?=?431); they reported poorer self-rated health (odds ratio [OR]?=?3.12; 95 % confidence interval [CI], 2.20–4.43), more symptoms of anxiety (OR?=?1.70; 95 % CI, 1.15–2.50), more diffuse somatic symptoms (OR?=?2.38; 95 % CI, 1.61–3.51) and more musculoskeletal symptoms (OR?=?1.21; 95 % CI, 1.13–1.29). Individuals still suffering from whiplash also visited more health practitioners at baseline (OR?=?1.18; 95 % CI, 1.06–1.32) and used more medications (OR?=?1.24; 95 % CI, 1.09–1.40).

Conclusion

Poor self-rated health seems to be a strong risk factor for whiplash injuries becoming chronic. Diffuse somatic symptoms, musculoskeletal symptoms and symptoms of anxiety at baseline are important prognostic risk factors. Knowledge of these maintaining risk factors enables identification of individuals at risk of non-recovery, facilitating adequate treatment for this vulnerable group.     

Interest and Use of Mental Health and Specialty Behavioral Medicine Counseling in US Primary Care Patients

Background

Counseling interventions have the potential to improve health and quality of life for primary care patients, but there are few studies describing the interest in and utilization of counseling among this patient population in the USA.

Purpose

The purpose of the study was to evaluate interest in mental health and specialty behavioral medicine counseling and predictors of utilization over 1 year among US primary care patients.

Method

Participants in this two-survey longitudinal study included 658 primary care patients in an urban US academic medical center (461 females, age M?=?51.05, SD?=?15.46 years). Retention rate was 61.2% at survey 2. Patient demographics, depression, anxiety, and interest in counseling services were assessed through a survey mailed 1 week following an outpatient appointment. Respondents to survey 1 were re-contacted 1 year later to assess. Interest and use of the following counseling services were evaluated in the relevant subgroups: mental health (the entire sample and patients with elevated anxiety and/or depression), health/lifestyle (overweight and obese participants), smoking cessation (current and occasional smokers), and pain management (participants with elevated daily pain ratings).

Results

At survey 1, 45.7% of the sample reported interest in mental health counseling, and 58.9% of the sample reported interest in behavioral medicine counseling. Among overweight or obese participants, 59.9% were interested in health/lifestyle counseling. Among smokers, 55.3% were interested in smoking cessation, and among participants with chronic pain, 33.8% were interest in pain management. Rates of utilization of services at survey 2 were 21.3% for mental health, 7.7% for health/lifestyle, 6.7% for smoking cessation, and 6.6% for pain management. Interest in receiving services at survey 1 was the strongest predictor of utilization.

Conclusion

Results demonstrate high interest but low utilization over 1 year among US primary care patients. Identifying patients interested in counseling services and reducing barriers may help facilitate receipt of services for those with interest and need for behavioral treatments.     

Association of Psychiatric History and Type D Personality with Symptoms of Anxiety, Depression, and Health Status Prior to ICD Implantation

Background

Personality factors and psychiatric history may help explain individual differences in risk of psychological morbidity and poor health outcomes in patients with an implantable cardioverter defibrillator (ICD).

Purpose

We examined associations between previous anxiety and depressive disorder, type D personality, anxiety or depressive symptoms, and health status in ICD patients prior to ICD implantation.

Method

Patients (N?=?278; 83 % men; mean age?=?62.2 years ±11) receiving a first ICD from September 2007 through April 2010 at the Medisch Spectrum Twente, The Netherlands completed validated questionnaires before implantation assessing type D personality (14-item Type D Scale), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale), and health status (36-item Short Form Health Survey). History of anxiety or depressive disorder was assessed with the Mini International Neuropsychiatric Interview structural interview.

Results

Previous anxiety or depressive disorder was prevalent in 8 and 19 % of patients, respectively. Type D personality was present in 21 %, depressive symptoms in 15 %, and anxiety in 24 %. In adjusted analyses, type D personality was a dominant correlate of previous depressive disorder (odds ratio (OR) 6.2, p?<?0.001) and previous anxiety disorder (OR 3.9, p?=?0.004). Type D personality (OR 4.0, p?<?0.001), age (OR 1.03, p?=?0.043), and gender (OR 2.5, p?=?0.013) were associated with anxiety symptoms at baseline. Type D personality (OR 5.9. p?<?0.001) was also associated with increased depressive symptoms at baseline. Heart failure and type D personality were related to poorer health status.

Conclusion

In ICD patients, prior to ICD implantation, a previous anxiety or depressive disorder, type D personality, and anxiety and depressive symptoms were associated with poorer health status. Type D personality was also independently associated with increased anxiety and depression symptoms.     

Work-focused cognitive behavioral intervention for psychological complaints in patients on sick leave due to work-related stress: Results from a randomized controlled trial

Background

Work-related stress is a global problem with negative implications for individuals and society. The purpose of the current study was to evaluate a stress management intervention for patients on sick leave due to work-related stress complaints using a three-armed randomized controlled design.

Methods

Participants were patients referred from three municipalities to the regional Department of Occupational Medicine. Inclusion criteria were: 1) sick leave due to work-related stress complaints, 2) a diagnosis of adjustment disorder or reactions to severe stress (ICD 10 code: F43,2 – F 43,9 not PTSD) or mild depressive episode (F 32.0). Through a double randomization procedure patients (n = 163) were randomized to either an intervention group (n = 58), a ‘control group A’ receiving a clinical examination (n = 56), or ‘control group B’ (n = 49) receiving no offers at the department. The intervention comprised six sessions of individual cognitive behavioral therapy and the offer of a small workplace intervention. Questionnaire data were analyzed with multivariate repeated measurements analysis. Primary outcomes assessed were perceived stress and general mental health. Secondary outcomes were sleep quality and cognitive failures. Follow-up was at four and 10 months after baseline.

Results

Complaints were significantly reduced in all groups over time. No group effects were observed between the intervention group and control group A that was clinically assessed. Significant group effects were found for perceived stress and memory when comparing the intervention group to group B, but most likely not due to an intervention effect.

Conclusion

Psychological complaints improved substantially over time in all groups, but there was no significant treatment effect on any outcomes when the intervention group was compared to control group A that received a clinical assessment.

Trial registration

ISRCTN ISRCTN91404229. Registered 03 August 2012 (retrospectively registered).

     

Mental Health and Asthma in China: the Guangzhou Biobank Cohort Study

Background

There is consistent evidence of the co-occurrence of poor mental health and asthma in Western populations. Since the experience and expression of mental health is partly culturally determined, it is of interest to examine if similar associations are found in other cultural settings. In that regard, very little is known about the association between mental health and asthma in Asian countries, such as China.

Purpose

The aim of this study was to investigate the relationship between mental health and asthma in a large sample from China.

Method

We used data from the Guangzhou Biobank Cohort Study phase 3 (n?=?9,280). Participants reported physician-diagnosed asthma. Mental health measures included the 15-item Chinese version of the Geriatric Depression Scale (GDS-C) and the SF-12 Mental Component Summary (MCS) score. We compared the prevalence of asthma by GDS-C and MCS scores by estimating prevalence ratios (PRs) and their corresponding 95% confidence intervals (95% CI), using Poisson regression.

Results

Compared to those without depression, the prevalence of asthma was higher in those with moderate or severe depression levels (PR?=?2.63, 95% CI?=?1.58–4.40 and PR?=?4.43, 95% CI?=?1.62–12.09, p for trend ≤0.0001). The prevalence of asthma increased by 46% with every 1 standard deviation increase of the GDS-C score (PR?=?1.46, 95% CI?=?1.24–1.73). The MCS score was not associated with asthma.

Conclusion

Depressive symptoms were associated with asthma prevalence in a Chinese population. Further research into the mechanism and potential directions of causality is warranted.     

Associations Between Supportive Leadership and Employees Self-Rated Health in an Occupational Sample

Background

Protecting the health of the work force has become an important issue in public health research.

Purpose

This study aims to explore potential associations between supportive leadership style (SLS), an aspect of leadership behavior, and self-rated health (SRH) among employees.

Method

We drew on cross-sectional data from a cohort of industrial workers (n?=?3,331), collected in 2009. We assessed employees' ratings of supportive, employee-oriented leadership behavior at their job, their SRH, and work stress as measured by the effort–reward model and scales measuring demands, control, and social support. Logistic regression estimated odds ratios (ORs) and corresponding 95 % confidence intervals (CIs) for the association between the perception of poor SLS and poor SRH controlling for work-related stress and other confounders. Sensitivity analyses stratified models by sex, age, and managerial position to test the robustness of associations.

Results

Perception of poor SLS was associated with poor SRH [OR 2.39 (95 % CI 1.95–2.92)]. Although attenuated following adjustment for measures of work-related stress and other confounders [OR 1.60 (95 % CI 1.26–2.04)], the magnitude, direction, and significance of this association remained robust in stratified models in most subgroups.

Conclusion

SLS appears to be relevant to health in the workplace. Leadership behavior may represent a promising area for future research with potential for promoting better health in a large segment of the adult population.     

Initial Responses of Different Health Care Professionals to Various Patients with Headache: Which are Perceived as Difficult?

Background

Somatizing patients are considered a challenge to health care professionals.

Purpose

The purpose of this study was to investigate the responses of different health care professionals’ to patients with headache with different presentations.

Method

Medical professionals (n?=?77), clinical psychologists (n?=?40), and psychology students (n?=?115) were shown with four different manifestations of headache (neutral, somatic trauma, anxious–depressed, and severe somatizing). Health professionals rated their initial cognitive and emotional responses using a standardized questionnaire.

Results

The severe somatizing and anxious–depressed patients with headache evoked significantly more negative cognitive and emotional responses in all three samples. Even brief exposure to a patient's story yields specific initial responses from various health care professionals irrespective of their disciplines.

Conclusion

Patients with headache and with a distressed presentation evoke significantly more negative cognitive and emotional responses in different health care professionals. Health care professionals should be more aware of their own response to difficult patients; in this way they will be more capable of managing this patient group.     

Relationship Between Religiosity and Health: Evidence from a Post-communist Country

Background

The relationship between religiosity and health has been investigated in the western world for decades. However, very little data are available from the post-communist region of Europe, where religion was suppressed for a long time.

Purpose

The aim of the present study was to lessen this gap.

Methods

In 2002, 13 years after the regime change, 12,643 persons (mean age?=?47.6?±?17.9 years; 44.8 % male) were interviewed in a Hungarian representative survey. The relationship of mental and physical health indicators with religious worship and personal importance of religion—controlling for several psychological and lifestyle characteristics—were analyzed using the general linear model procedure.

Results

Our results showed that practicing religion was largely associated with better mental health and more favorable physical health status. However, persons being religious in their own way tended to show more unfavourable results across several variables when compared to those practicing religion regularly in a religious community or even to those considering themselves as non-religious. The personal importance of religion showed a mixed pattern, since it was positively associated not only with well-being but depression and anxiety as well.

Conclusions

We can conclude that even after an anti-religious totalitarian political system practicing religion still remained a health protecting factor.     

Effect of a Telephone-Delivered Coronary Heart Disease Secondary Prevention Program (ProActive Heart) on Quality of Life and Health Behaviours: Primary Outcomes of a Randomised Controlled Trial

Background

Participation in coronary heart disease secondary prevention programs is low. Innovative programs to meet this treatment gap are required.

Purpose

To aim of this study is to describe the effectiveness of a telephone-delivered secondary prevention program for myocardial infarction patients.

Methods

Four hundred and thirty adult myocardial infarction patients in Brisbane, Australia were randomised to a 6-month secondary prevention program or usual care. Primary outcomes were health-related quality of life (Short Form-36) and physical activity (Active Australia Survey).

Results

Significant intervention effects were observed for health-related quality of life on the mental component summary score (p?=?0.02), and the social functioning (p?=?0.04) and role-emotional (p?=?0.03) subscales, compared with usual care. Intervention participants were also more likely to meet recommended levels of physical activity (p?=?0.02), body mass index (p?=?0.05), vegetable intake (p?=?0.04) and alcohol consumption (p?=?0.05).

Conclusions

Telephone-delivered secondary prevention programs can significantly improve health outcomes and could meet the treatment gap for myocardial infarction patients.     

Somatic Symptoms and Holistic Thinking as Major Dimensions Behind Modern Health Worries

Background

Modern health worries (MHWs) were related to somatic symptoms and to preference of holistic healing methods in previous studies.

Purpose

The study aimed to investigate the contribution of symptom-related and holism-related factors to MHWs.

Methods

Participants (visitors of an Internet news portal; N?=?16152; 64.1 % males) completed a questionnaire assessing MHWs, somatosensory amplification, somatic symptoms, positive and negative affect, spirituality, holistic health beliefs, and various aspects of health care utilization (both conventional and alternative).

Results

Exploratory factor analysis with oblique rotation revealed two independent dimensions (“Somatic symptom distress” and “Holism”) MHWs were involved with factor loadings of 0.294 and 0.417, respectively. The existence of two factors was supported by the results of confirmatory factor analysis. No practically significant interaction between the two factors was found in binary logistic regression analysis. Positive and negative affect, somatosensory amplification, spirituality, and holistic health beliefs were positively connected, while self-rated health status was negatively connected to MHWs even after controlling for socio-demographic and treatment-related variables.

Conclusions

Holistic thinking and symptom-related behavioral and psychological factors are independently associated with MHWs. Modern health worries can be conceptualized as symptom-related by-products of a holistic–spiritual worldview.     

Impact of an Educational Programme on Reproductive Health Among Young Migrant Female Workers in Shenzhen,China: an Intervention Study

Background

Reproductive health and sexually transmitted diseases (STD) account for a high proportion of health problems in the rural-to-urban young female migrant workers in China. Improving these conditions remains highly challenging.

Purpose

To developed an educational programme to advance the reproductive health of the female workers.

Method

An intervention study was conducted between July 2010 and April 2011 in Shenzhen. Two commune factories were selected to participate and provided a control cluster receiving routine local government health services and a second cluster receiving an educational intervention in addition to the routine services. The intervention included distribution and free access to educational study materials. The factory workers’ knowledge, attitudes and behaviour in the area of reproductive health and STD were the main study outcomes.

Results

Compared with the control cluster, at the 6-month follow-up assessment, the intervention cluster had a significantly higher proportion of correct answers to queries about human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (standardised coefficients of multiple linear regression (B) 0.047; P?=?0.020) and awareness of places providing free contraceptives (odds ratio [OR] 2.011, 95 % confidence interval [CI] 1.635–2.472; P?<?0.001), and a significantly lower proportion accepting premarital sex (OR 0.492, 95 % CI 0.416–0.582; P?<?0.001), practising premarital sex (OR 0.539, 95 % CI 0.478–0.608; P?<?0.001) or suffering from gynaecological disorders (OR 0.801, 95 % CI 0.697–0.921; P?=?0.002).

Conclusion

A community-based educational intervention targeting unmarried female migrant workers appears to be effective in substantially improving their knowledge of reproductive health and their attitudes and behaviour towards health, and in reducing prevalence of STD.     

Type D Personality, Temperament, and Mental Health in Military Personnel Awaiting Deployment

Background

The Type D (distressed) personality refers to a general propensity to psychological distress defined by the combination of negative affectivity and social inhibition. Type D personality predicts poor mental and physical health in cardiac patients, but it has been argued that its assessment is affected by the state of illness. Therefore, validation of the Type D construct in healthy adults remains essential.

Purpose

The objectives of this study were (1) to validate Type D personality against temperament and character dimensions in young, healthy adults and (2) to investigate the association between Type D personality and pre-deployment mental health.

Method

Type D personality, temperament, and questionnaires on mental health were filled out by 86 healthy male Dutch military personnel before UN deployment to Afghanistan.

Results

Type D personality was present in 16% of healthy military personnel before deployment. The Type D components social inhibition (α?=?0.89) and negative affectivity (α?=?0.85) correlated positively with harm avoidant temperament (r?=?0.66 and 0.46) and negatively with self-directed character (r?=??0.33 and ?0.57). In addition, these four traits loaded on the same broad personality dimension. Military men with a Type D personality not only reported significantly less self-directedness and more harm avoidance as compared to non-Type D men (p?<?0.001) but also more symptoms of PTSD, general emotional distress, and hostility (all p?<?0.012).

Conclusions

Type D personality was associated with harm avoidance, low self-directedness, and increased symptoms of PTSD and hostility in men awaiting deployment. This association was not caused by any somatic confounding in these young, healthy men.     

The Distinction Between “Medically Unexplained” and “Medically Explained” in the Context of Somatoform Disorders

Purpose

Medically unexplained symptoms (MUS) currently constitute the main diagnostic criterion of somatoform disorders. It has been proposed that the required dichotomization of somatic complaints into MUS and medically explained symptoms (MES) should be abandoned in DSM-V. The present study investigated complaints in the general population in order to evaluate the relevance of a distinction between MUS and MES.

Methods

Three hundred twenty-one participants from a population-based sample were interviewed by telephone to assess symptoms present during the previous 12 months. Complaints were examined in terms of health care use, diagnoses made by the physician and degree of impairment. At the 1-year follow-up, 244 subjects were re-interviewed in order to explore the stability of symptoms.

Results

The complaints frequently prompted participants to seek medical health care (several pain and pseudoneurological symptoms led to a doctors' visit in >80 % of cases), although etiological findings rarely suggested a medical pathology (occasionally <30 %). MUS and MES proved, to an equal degree, to impair individuals and prompt a change in lifestyle. Pain caused the worst impairment compared with other symptoms. The most prevalent MUS and MES were characterized by a transient course (approximately 60 % remitted, 55 % newly emerged to follow-up), although various unexplained pain complaints tended to be persistent (e.g., back pain 67 %). Remarkably, the appraised etiology as explained or unexplained changed from baseline to follow-up in many persisting symptoms (20 % MUS → MES, 50 % MES → MUS).

Conclusions

In principal, MUS and MES resulted in comparable impairment and stability. Due to conceptual and methodological difficulties, classification criteria for somatoform disorders should not be restricted to somatic aspects of the symptomatology.     

Predictors of Health Behavior Change After an Integrative Medicine Inpatient Program

Background

Health behavior change can improve physical and psychosocial outcomes in internal medicine patients.

Purpose

This study aims to identify predictors for health behavior change after an integrative medicine inpatient program.

Method

German internal medicine patients' (N?=?2,486; 80 % female; 53.9?±?14.3 years) practice frequency for aerobic exercise (e.g., walking, running, cycling, swimming), meditative movement therapies (e.g., yoga, tai ji, qigong), and relaxation techniques (e.g., progressive relaxation, mindfulness meditation, breathing exercises, guided imagery) was assessed at admission to a 14-day integrative medicine inpatient program, and 3, 6, and 12 months after discharge. Health behavior change was regressed to exercise self-efficacy, stage of change, and health locus of control (internal, external-social, external-fatalistic).

Results

Short-term increases in practice frequency were found for aerobic exercise: short- and long-term increases for meditative movement therapies and relaxation techniques (all p?p?p?Conclusion Health behavior change after an integrative medicine inpatient program was predicted by self-efficacy, stage of change, and health locus of control. Considering these aspects might improve adherence to health-promoting behavior after lifestyle modification programs.     

Stress Underestimation and Mental Health Outcomes in Male Japanese Workers: a 1-Year Prospective Study

Purpose

Being appropriately aware of the extent of stress experienced in daily life is essential in motivating stress management behaviours. Excessive stress underestimation obstructs this process, which is expected to exert adverse effects on health. We prospectively examined associations between stress underestimation and mental health outcomes in Japanese workers.

Methods

Web-based surveys were conducted twice with an interval of 1 year on 2359 Japanese male workers. Participants were asked to complete survey items concerning stress underestimation, depressive symptoms, sickness absence, and antidepressant use.

Results

Multiple logistic regression analysis revealed that high baseline levels of ‘overgeneralization of stress’ and ‘insensitivity to stress’ were significantly associated with new-onset depressive symptoms (OR?=?2.66 [95 % CI, 1.54–4.59], p?<?.01) and antidepressant use (OR?=?4.91 [95 % CI, 1.22–19.74], p?<?.05), respectively, during the 1-year follow-up period.

Conclusions

This study clearly demonstrated that stress underestimation, including stress insensitivity and the overgeneralization of stress, could exert adverse effects on mental health.