Past and familial depression predict current symptoms of professional burnout

BACKGROUND: Despite a substantial association between professional burnout and depression, the exact nature of the relationship is unclear. It is hypothesized that an underlying susceptibility for depression is associated with an enhanced risk for professional burnout. In the present study, the relationship was examined between indices of personal and familial history of depression and current symptoms of burnout. METHODS: Respondents were 3385 employees of different work settings (61% female, age 18-65 years), who completed questionnaires regarding demographic variables, working hours, personal and familial history of depression, current depressive symptomatology, and current symptoms of professional burnout. RESULTS: After controlling for background variables, the strongest predictor of all three burnout facets was current depressive symptomatology. Independent of the effects of background variables and current depressive symptoms, having ever experienced a depressive episode further predicted current symptoms of two burnout facets: emotional exhaustion (OR=1.82, 95% CI=1.38-2.40, P<0.001) and cynicism (OR=1.51, 95% CI=1.16-1.98, P=0.002). In addition, a history of depression in close family members independently predicted current symptoms of emotional exhaustion (OR=1.63, 95% CI=1.27-2.10, P<0.001), while a trend appeared for a similar effect on cynicism (OR=1.23, 95% CI=0.96-1.58, P=0.095). LIMITATIONS: The study is based on a cross-sectional retrospective design. CONCLUSIONS: A predisposition for depression, as reflected by a personal and familial history of depression, may enhance the risk for burnout.     

江苏盐城地区留守儿童抑郁状况及相关因素

目的:了解江苏盐城地区留守儿童的抑郁状况及相关的影响因素。方法:采用自制的一般资料问卷及儿童抑郁问卷(Children's Depression Inventory,CDI)对盐城地区3所农村中心小学356名留守儿童进行调查。结果:留守儿童的抑郁检出率为25.6%。Logistic回归分析显示,与父母交流频率为每半年(P0.001,OR=7.321,95%CI=2.876~15.128)、双亲缺失型留守儿童(P=0.021,OR=2.134,95%CI=1.654~6.980)、交流中谈论日常琐事(P=0.006,OR=4.321,95%CI=1.908~9.978)、家庭年收入为0~2000元(P=0.012,OR=3.223,95%CI=2.011~8.830)、5~6年级(P=0.003,OR=8.342,95%CI=2.113~19.232)、11~13岁(P=0.015,OR=5.299,95%CI=1.809~15.098)为留守儿童抑郁发生的危险因子,而交流内容为自我感受(P=0.001,OR=0.342,95%CI=0.190~0.799)、1~2年级(P0.001,OR=0.543,95%CI=0.221~0.879)、7~8岁(P0.001,OR=0.655,95%CI=0.207~0.911)为留守儿童抑郁的抗性因素。结论:盐城地区留守儿童的抑郁发生率较高,危险因素和抗性因素应当给予关注。     

Job strain, job insecurity, and health: rethinking the relationship

Job strain (high demands and low control) is a widely used measure of work stress. The authors introduce a new way of looking at work stress by combining job strain with job insecurity, a combination increasingly prevalent in contemporary economies, using data from a cross-sectional survey (N = 1,188) of mid-aged Australian managers and professionals. Those reporting both strain and insecurity showed markedly higher odds for mental and physical health problems (depression: odds ratio [OR] 13.88, 95% confidence interval [CI] 5.67-34.01; anxiety: OR 12.88, CI 5.12-32.39; physical health problems: OR 3.97, CI 1.72-9.16; and poor self-rated health: OR 7.12, CI 2.81-18.01). Job strain and insecurity showed synergistic associations with health, and employees experiencing both could be at heightened health risk.     

Two year reduction in sleep apnea symptoms and associated diabetes incidence after weight loss in severe obesity

STUDY OBJECTIVES: To evaluate the effect of bariatric surgery on sleep apnea symptoms and obesity-associated morbidity in patients with severe obesity. DESIGN: Prospective study. SETTING: University hospitals and community centers in Sweden. Intervention: We investigated the influence of weight loss surgery (n=1729) on sleep apnea symptoms and obesity-related morbidity using a conservatively treated group (n=1748) as a control. MEASUREMENTS AND RESULTS: Baseline BMI in surgical group (42.2+/-4.4 kg/m(2)) and control group (40.1+/-4.6 kg/m(2)) changed -9.7+/-5 kg/m(2) and 0+/-3 kg/m(2), respectively, at 2-year follow-up. In the surgery group, there was a marked improvement in all obstructive sleep apnea (OSA) symptoms compared with the control group (P <0.001). Persistence of snoring (21.6 vs 65.5%, adjusted OR 0.14, 95% CI 0.10-0.19) and apnea (27.9 vs 71.3%, adjusted OR 0.16, 95% I 0.10-0.23) were much less in the surgery group compared with controls. Compared with subjects with no observed apnea at follow-up (n=2453), subjects who continued to have or developed observed apnea (n=404) had a higher incidence of diabetes (adjusted OR 2.03, 95% CI 1.19-3.47) and hypertriglyceridemia (adjusted OR 1.86, 95% CI 1.07-3.25) but not hypertension (adjusted OR 1.09, 95% CI 0.65-1.83) or hypercholesterolemia (adjusted OR 0.91, 95% CI 0.53-1.58). CONCLUSION: Bariatric surgery results in a marked improvement in sleep apnea symptoms at 2 years. Despite adjustment for weight change and baseline central obesity, subjects reporting loss of OSA symptoms had a lower 2-year incidence of diabetes and hypertriglyceridemia. Improvement in OSA in patients losing weight may provide health benefits in addition to weight loss alone.     

Effectiveness of a web-based self-help intervention for symptoms of depression, anxiety, and stress: randomized controlled trial

Background

Self-help therapies are often effective in reducing mental health problems. We developed a new Web-based self-help intervention based on problem-solving therapy, which may be used for people with different types of comorbid problems: depression, anxiety, and work-related stress.

Objective

The aim was to study whether a Web-based self-help intervention is effective in reducing depression, anxiety, and work-related stress (burnout).

Methods

A total of 213 participants were recruited through mass media and randomized to the intervention (n = 107) or a waiting list control group (n = 106). The Web-based course took 4 weeks. Every week an automated email was sent to the participants to explain the contents and exercises for the coming week. In addition, participants were supported by trained psychology students who offered feedback by email on the completed exercises. The core element of the intervention is a procedure in which the participants learn to approach solvable problems in a structured way. At pre-test and post-test, we measured the following primary outcomes: depression (CES-D and MDI), anxiety (SCL-A and HADS), and work-related stress (MBI). Quality of life (EQ-5D) was measured as a secondary outcome. Intention-to-treat analyses were performed.

Results

Of the 213 participants, 177 (83.1%) completed the baseline and follow-up questionnaires; missing data were statistically imputed. Of all 107 participants in the intervention group, 9% (n = 10) dropped out before the course started and 55% (n = 59) completed the whole course. Among all participants, the intervention was effective in reducing symptoms of depression (CES-D: Cohen’s d = 0.50, 95% confidence interval (CI) 0.22-0.79; MDI: d = 0.33, 95% CI 0.03-0.63) and anxiety (SCL-A: d = 0.42, 95% CI 0.14-0.70; HADS: d = 0.33, 95% CI 0.04-0.61) as well as in enhancing quality of life (d = 0.31, 95% CI 0.03-0.60). Moreover, a higher percentage of patients in the intervention group experienced a significant improvement in symptoms (CES-D: odds ratio [OR] = 3.5, 95% CI 1.9-6.7; MDI: OR = 3.7, 95% CI 1.4-10.0; SCL-A: OR = 2.1, 95% CI 1.0-4.6; HADS: OR = 3.1, 95% CI 1.6-6.0). Patients in the intervention group also recovered more often (MDI: OR = 2.2; SCL-A: OR = 2.0; HADS < 8), although these results were not statistically significant. The course was less effective for work-related stress, but participants in the intervention group recovered more often from burnout than those in the control group (OR = 4.0, 95% CI 1.2-13.5).

Conclusions

We demonstrated statistically and clinically significant effects on symptoms of depression and anxiety. These effects were even more pronounced among participants with more severe baseline problems and for participants who fully completed the course. The effects on work-related stress and quality of life were less clear. To our knowledge, this is the first trial of a Web-based, problem-solving intervention for people with different types of (comorbid) emotional problems. The results are promising, especially for symptoms of depression and anxiety. Further research is needed to enhance the effectiveness for work-related stress.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN) 14881571     

Depressive symptoms, neurocognitive impairment, and adherence to highly active antiretroviral therapy among HIV-infected persons

The association of depressive symptoms, neurocognitive impairment, and adherence to highly active antiretroviral therapy (HAART) was evaluated in 135 HIV-infected persons. Thirty percent reported nonadherence to HAART. Depressive symptoms (assessed with the Montgomery-Asberg Depression Rating Scale) and neurocognitive impairment (assessed with a neuropsychological test battery) were documented in 24% and 12%, respectively, of the study participants. Nonadherence to HAART was independently associated with worse depression rating scale scores (odds ratio=1.05, 95% confidence interval [CI]=1.00-1.10), acquisition of HIV through injection of drugs (odds ratio=2.59, 95% CI=1.05-6.39), and complaints about impairment of sexual activity (odds ratio=6.62, 95% CI=1.16-37.6). The presence of depressive symptoms, but not neurocognitive impairment, was associated with nonadherence.     

Depressive disorder as a long-term antecedent risk factor for incident back pain: a 13-year follow-up study from the Baltimore Epidemiological Catchment Area sample

BACKGROUND: The co-occurrence of affective distress and back pain is well documented but the relationship between them is less certain. This study examines the relationship between lifetime occurrence of depressive disorder and incident back pain reported over a 13-year period. METHOD: The Baltimore Epidemiologic Catchment Area Study is a prospective study of a household-residing cohort, selected probabilistically from East Baltimore in 1981. Between 1982-3 (wave 2) and again between 1993-6 (wave 3), a follow-up study of the original cohort was conducted. Questions on depressive disorder and back pain were drawn from the Diagnostic Interview Schedule. Logistic regression analyses were used to evaluate whether depressive disorder acts as a risk factor for incident back pain. RESULTS: In cross-sectional analyses, lifetime occurrence of depressive disorder was a significant correlate of lifetime prevalence of back pain at wave 1 (OR = 1.6, P = 0.01). During the 13-year follow-up, across three data collection points, there was an increase in the risk for incident back pain when depressive disorder was present at baseline (OR = 1.9, 95% CI 1.03, 3.4). However, during the short-term follow-up period of 1 year, between baseline and wave 2, depressive disorder at baseline was unrelated to first-ever reports of back pain. Lifetime depressive disorder in both waves 1 (baseline) and 2 (1 year later) was associated with a more than three times greater risk for a first-ever report of back pain during the 12 to 13 year follow-up period, in comparison to those who did not have depressive disorder at waves 1 or 2 (OR = 3.4, 95% CI 1.4, 7.8). Back pain at wave 1 was not significantly associated with an increased risk for depression in the longitudinal analysis (OR = 0.8, 95% CI 0.5, 1.4). CONCLUSIONS: Depressive disorder appears to be a risk factor for incident back pain independent of other characteristics often associated with back pain. Back pain is not a short-term consequence of depressive disorder but emerges over periods longer than 1 year. Moreover, in this study the alternative pathway of back pain as a risk factor for depressive disorder could not be supported.     

Recognizing increased risk of depressive comorbidity after myocardial infarction: looking for 4 symptoms of anxiety-depression

BACKGROUND: Screening for depression in myocardial infarction (MI) patients must be improved: (1) depression often goes unrecognized and (2) anxiety has been largely overlooked as an essential feature of depression in these patients. We therefore examined the co-occurrence of anxiety and depression after MI, and the validity of a brief mixed anxiety-depression index as a simple way to identify post-MI patients at increased risk of comorbid depression. METHODS: One month after MI, 176 patients underwent a psychiatric interview and completed the Beck Depression Inventory (BDI) and the Symptoms of Anxiety-Depression index (SAD(4)) containing four symptoms of anxiety (tension, restlessness) and depression (feeling blue, hopelessness). RESULTS: Thirty-one MI patients (18%) had comorbid depression and 37 (21%) depressive or anxiety disorder. High factor loadings and item-total correlations (SAD(4), alpha = 0.86) confirmed that symptoms of anxiety and depression co-occurred after MI. Mixed anxiety-depression (SAD(4)>or=3) was present in 90% of depressed MI patients and in 100% of severely depressed patients. After adjustment for standard depression symptoms (BDI; OR = 4.4, 95% CI 1.6-12.1, p = 0.004), left ventricular ejection fraction, age and sex, mixed anxiety-depression symptomatology was associated with an increased risk of depressive comorbidity (OR = 11.2, 95% CI 3.0-42.5, p < 0.0001). Mixed anxiety-depression was also independently associated with depressive or anxiety disorder (OR = 9.2, 95% CI 3.0-27.6, p < 0.0001). CONCLUSIONS: Anxiety is underrecognized in post-MI patients; however, the present findings suggest that anxiety symptomatology should not be overlooked in these patients. Depressive comorbidity after MI is characterized by symptoms of mixed anxiety-depression, after controlling for standard depression symptoms. The SAD(4) represents an easy way to recognize the increased risk of post-MI depression.     

Personality disorders and depressive symptoms in late luteal phase dysphoric disorder

BACKGROUND: Although many significant studies of late luteal phase dysphoric disorder (LLPD) have been carried out, some conflicting findings on the relationships between personality disorders, depressive symptoms, hostility and LLPD deserve further investigation. METHODS: Forty-three LLPD patients and 85 control subjects, evaluated by prospective daily ratings during two symptomatic cycles, received a detailed psychiatric evaluation, including the sections for psychotic, affective and anxiety disorders of the Structured Clinical Interview for DSM-III-R nonpatient version and the section for personality disorders; the Buss Durkee Inventory for Assessing Different Kinds of Hostility and the Montgomery-Asberg Depression Rating Scale. RESULTS: The odds of suffering from LLPD are about nine-fold (crude odds ratio, OR = 9.23, 95% confidence interval, CI 3.98-21.39) among women with mild or moderate depressive symptoms. When two age strata (below and above 30) are analyzed separately, the association between LLPD and depressive symptoms is strong and positive in both strata, while the association between LLPD and avoidant personality disorder is found only among older women (adjusted OR = 8.26, p < 0.05, 95% CI 1.03-66.35). CONCLUSIONS: The major finding from this preliminary study is the association between LLPD and depressive symptoms. Conversely, the association between LLPD and avoidant personality disorder remains controversial and seems to be dependent on age. Our findings support the hypothesis that LLPD and avoidant personality disorder may be considered as part of the spectrum of recurrent mood disorder rather than as qualitatively distinct nosological entities. Future studies are needed, adopting prospective, longitudinal assessments of personality prior to the onset of LLPD.     

Enhanced treatment for depression in primary care: long-term outcomes of a psycho-educational prevention program alone and enriched with psychiatric consultation or cognitive behavioral therapy

BACKGROUND: The long-term outcome of major depression is often unfavorable, and because most cases of depression are managed by general practitioners (GPs), this places stress on the need to improve treatment in primary care. This study evaluated the long-term effects of enhancing the GP's usual care (UC) with three experimental interventions. METHOD: A randomized controlled trial was conducted from 1998 to 2003. The main inclusion criterion was receiving GP treatment for a depressive episode. We compared: (1) UC (n=72) with UC enhanced with: (2) a psycho-educational prevention (PEP) program (n=112); (3) psychiatrist-enhanced PEP (n=37); and (4) brief cognitive behavioral therapy followed by PEP (CBT-enhanced PEP) (n=44). We assessed depression status quarterly during a 3-year follow-up. RESULTS: Pooled across groups, depressive disorder-free and symptom-free times during follow-up were 83% and 17% respectively. Almost 64% of the patients had a relapse or recurrence, the median time to recurrence was 96 weeks, and the mean Beck Depression Inventory (BDI) score over 12 follow-up assessments was 9.6. Unexpectedly, PEP patients had no better outcomes than UC patients. However, psychiatrist-enhanced PEP and CBT-enhanced PEP patients reported lower BDI severity during follow-up than UC patients [mean difference 2.07 (95% confidence interval (CI) 1.13-3.00) and 1.62 (95% CI 0.70-2.55) respectively] and PEP patients [2.37 (95% CI 1.35-3.39) and 1.93 (95% CI 0.92-2.94) respectively]. CONCLUSIONS: The PEP program had no extra benefit compared to UC and may even worsen outcome in severely depressed patients. Enhancing treatment of depression in primary care with psychiatric consultation or brief CBT seems to improve the long-term outcome, but findings need replication as the interventions were combined with the ineffective PEP program.     

The relationship between job-related burnout and depressive disorders--results from the Finnish Health 2000 Study

BACKGROUND: Depression and burnout are common health problems in working populations today. They appear to be interrelated, and the need for their differential diagnosis has been highlighted in many reviews. We analysed the overlap of job-related burnout and depressive disorders, i.e., major depressive disorder, dysthymia, and minor depressive disorder. METHODS: We used the population-based 'Health 2000 Study' in Finland. Our nationally representative sample comprised 3276 employees aged 30-64 years. Burnout was assessed with the Maslach Burnout Inventory-General Survey. Diagnoses of depressive disorders were based on the Composite International Diagnostic Interview. RESULTS: Burnout and depressive disorders were clearly related. The risk of depressive disorders, especially major depressive disorder (12-month prevalence), was greater when burnout was severe. Half of the participants with severe burnout had some depressive disorder. Those with a current major depressive episode suffered from serious burnout more often than those who had suffered a major depressive episode earlier. LIMITATIONS: This study was cross-sectional. CONCLUSIONS: The concepts of burnout and depression complement each other and cover partly overlapping phenomena. Depressive disorders are related to job-related burnout, particularly when it is severe. A current major depressive episode is likely to be associated with the experience of burnout. When encountering working patients, it is recommended to assess both the occurrence of burnout and of depressive disorders.     

The association between C-reactive protein concentration and depression in later life is due to poor physical health: results from the Health in Men Study (HIMS)

BACKGROUND: C-reactive protein (CRP) is a non-specific marker of inflammation that has been associated with depression and vascular disease, particularly in men. This study aimed to investigate the association between high CRP concentration and depression while taking physical health into account. METHOD: A cross-sectional study of a community-dwelling sample of 5438 men aged 70+. Participants with scores > or =7 on the 15-item Geriatric Depression Scale (GDS-15) were considered to display clinically significant depressive symptoms. We measured the serum concentration of CRP with a high-sensitivity assay. The assessment of physical co-morbidity included three components: the Charlson weighted index, self-report of major health events on a standardized questionnaire, and the physical component of the 36-item Short-Form Health Survey (SF-36). Other measured factors included age, native language, education, a standardized socio-economic index, smoking, prior or current history of depression treatment, cognitive impairment (Mini-Mental State Examination score < 24 and body mass index (BMI). RESULTS: Participants with depression(n=340) wereolder than their controls without depression (age in years: 76.6 +/- 4.4 v. 75.4+/- 4.1). Men with CRP concentration > 3 mg/l had an increased odds ratio (OR) [1.59, 95% confidence interval (CI) 1.20-2.11] of being depressed compared to men with CRP 3 mg/l. This association became non-significant once we adjusted the analysis for the measures of physical co-morbidity and other confounding factors (OR 1.22, 95% CI 0.86-1.73). CONCLUSIONS: The physiological mechanisms that lead to the onset and maintenance of depressive symptoms in older men remain to be determined, but CRP concentration is unlikely to play a significant role in that process.     

Age and distress of women–results of a representative population-based study

Little research has been carried out on prevalence rates of distress (e.g. depression, posttraumatic stress symptoms (PTSS), hopelessness, and burnout) of women in different age groups. The aims of this study were to measure the prevalence rate of depression, posttraumatic stress symptoms, hopelessness, and burnout among women and to clarify the associations between age groups and distress. Cross sectional epidemiological study on women in Sweden (n = 6,000, aged 18–64 years, response rate 64.1%). Measures were questionnaires on socio-economic and work-related characteristics and on depression, posttraumatic stress symptoms, hopelessness, and burnout. Depression was measured with the “General Health Questionnaire” (GHQ), PTSS with the “Posttraumatic Symptom Scale”, hopelessness with the “Hopelessness Scale” and burnout with the “Shiron-Melamed Burnout Questionnaire” (SMBQ). The prevalence rate of depression varied from 12.5% to 14.1%; of posttraumatic stress symptoms from 23.5% to 33.3%; of hopelessness from 11.5% to 16%; and of burnout from 22.9% to 17.1%. Depression was not associated with age group. Hopelessness was associated with age group in univariate analysis bur not in multivariate analysis (OR = 0.7, 95% CI = 0.5–1.0). PTSS and burnout were associated with age group. Both symptoms were higher in the youngest age group, compared to the eldest age group (posttraumatic stress symptoms: OR = 1.6, 95% CI = 1.2, 2.1; burnout: OR = 1.5, 95% CI = 1.1–2.1). Younger women show higher prevalence rates of PTSS and burnout compared to elder women. The higher prevalence rates of PTSS and burnout among younger women may be associated with job strain and/or with violent life events.     

中小学教师工作压力、社会支持与职业倦怠的关系

目的探讨中小学教师工作压力、社会支持、职业倦怠之间的关系。方法采用职业倦怠问卷、工作压力问卷和社会支持问卷对1831名中小学教师进行测查。结果 1教师群体中,男性职业倦怠程度高于女性(F=1.925,P0.05),不同教龄的教师在成就感低落维度得分和职业倦怠总分上有显著差异(F=5.053,P0.01;F=2.801,P0.05),初中教师职业倦怠程度高于小学与高中教师(F=3.253,P0.05);2工作压力与职业倦怠呈正相关(r=0.27,0.42,0.38,0.49,0.35,0.43,0.28,0.29;P0.01),与支持利用度呈负相关(r=-0.06,-0.11,-0.53,-0.12,-0.13,-0.10,-0.09,-0.07;P0.01),社会支持与职业倦怠也呈负相关(r=-0.25,-0.31,-0.22;P0.01);3中小学教师社会支持在工作压力与职业倦怠之间起部分中介作用。结论工作压力既可以直接影响中小学教师职业倦怠,也可以通过社会支持间接影响职业倦怠。     

Impact of depressive symptoms on adult asthma outcomes.

BACKGROUND: Psychological disorders, including depression, are common in adults with asthma. Although depression is treatable, its impact on longitudinal asthma outcomes is not clear. OBJECTIVE: To elucidate the impact of depressive symptoms on patient-centered outcomes and emergency health care use in adults with asthma. METHODS: We conducted a prospective cohort study of 743 adults with asthma who were recruited after hospitalization for asthma. Depressive symptoms were defined as having a score of 16 or more on the Center for Epidemiologic Studies Depression Scale. We examined the impact of depressive symptoms on patient-centered outcomes (validated severity-of-asthma score, Marks Asthma Quality of Life Questionnaire, and 12-Item Short-Form Health Survey physical component summary score) and on future emergency health care use for asthma ascertained from computerized databases. RESULTS: The prevalence of depressive symptoms was 18% (95% confidence interval [CI], 15%-21%) among adults with asthma. Depressive symptoms were associated with greater severity-of-asthma scores after controlling for age, sex, race/ ethnicity, educational attainment, and cigarette smoking (mean score increment, 2.6 points; 95% CI, 1.8-3.4 points). Furthermore, depressive symptoms were associated with poorer asthma-specific quality of life (mean score increment, 19.9 points; 95% CI, 17.7-22.1 points) and poorer physical health status (mean score decrement, 3.7 points; 95% CI, 1.5-5.8 points). Depressive symptoms were associated with a greater longitudinal risk of hospitalization for asthma (hazard ratio, 1.34; 95% CI, 0.98-1.84). After controlling for differences in preventive care for asthma, the relationship was stronger (hazard ratio, 1.45; 95% CI, 1.05-2.0). CONCLUSION: Depressive symptoms are common in adults with asthma and are associated with poorer health outcomes, including greater asthma severity and risk of hospitalization for asthma.     

Relation of type A behavior pattern and job-related psychosocial factors to nonfatal myocardial infarction: a case-control study of Japanese male workers and women

OBJECTIVES: To study the relation of type A behavior pattern and job-related psychosocial factors to the risk of myocardial infarction. METHODS: Study subjects comprised 290 cases (173 male workers and 117 women) of nonfatal acute myocardial infarction (AMI) and 489 controls (303 male workers and 186 women) recruited from among residents of the study area. Participation rates of cases and controls were 86% and 50%, respectively. Type A behavior pattern, job-related psychosocial factors, and other coronary risk factors were ascertained by interview using a questionnaire. Type A behavior pattern was measured by 12 questions, and job strain by the method of Karasek. Logistic regression analysis was used to calculate odds ratio and 95% confidence interval with adjustment for potential confounding variables. The relation to job strain was examined only in men. RESULTS: Type A behavior pattern was significantly associated with an increased risk of AMI in male workers (adjusted OR = 1.9, 95% CI, 1.2-2.9) and in women (adjusted OR = 2.8, 95% CI, 1.6-4.9). Although job control and job demand showed no material association with AMI, job strain, a combination of low job control and high job demand was associated with an increased risk of AMI (adjusted OR = 2.2, 95% CI, 1.1-4.5). Abbreviated type A score and job demand score were higher among nonparticipant control candidates than participant controls in male workers. CONCLUSIONS: Type A behavior pattern may be an important risk factor for AMI especially in Japanese women. The present study also revealed persons in stressful psychosocial circumstances were less likely to participate in the study.     

Vasomotor symptoms are associated with depression in perimenopausal women seeking primary care

OBJECTIVE: To compare the relationship between vasomotor symptoms (hot flushes and night sweats) and depression in perimenopausal women with that in postmenopausal and older premenopausal women. DESIGN: Questionnaire data assessing current depressive symptoms (Center for Epidemiologic Studies Depression Scale), hot flushes, night sweats, menopausal status, depression history, hormonal therapy use, and demographic characteristics were collected from women aged 40 to 60 years seeking primary care. Multivariable logistic regression models were used to examine the relationship between vasomotor symptoms and depression. RESULTS: Depression (defined by a Center for Epidemiologic Studies Depression Scale score >/= 25) was observed in 14.9% of 141 perimenopausal women, 13.9% of 151 postmenopausal women, and 7.6% of 184 older premenopausal women. Recent vasomotor symptoms were reported by 53.9% of perimenopausal women, 43.7% of postmenopausal women, and 20.7% of older premenopausal women. Perimenopausal women with vasomotor symptoms were 4.39 times more likely to be depressed than those without vasomotor symptoms (95% CI, 1.40-13.83), an association that did not change after controlling for depression history. In contrast with perimenopausal women, postmenopausal and older premenopausal women with vasomotor symptoms did not have a significantly greater risk for depression than women of the same menopausal status without vasomotor symptoms (adjusted odds ratios, 1.28 and 1.77; 95% CI, 0.47-3.46 and 0.53-5.89, respectively). CONCLUSIONS: Hot flushes and night sweats are associated with depression in perimenopausal women. Further investigation is warranted to elucidate the mechanism by which hot flushes may be associated with depression in perimenopausal women and not in postmenopausal or older premenopausal women.     

Detecting suicidal ideation in older patients: identifying risk factors within the general practice setting

BACKGROUND: GPs are the most frequently accessed health professional among suicidal individuals in the community.AIM: To determine the prevalence of psychological distress and suicidal ideation among patients aged 60 years and older presenting to GPs, and the relationship between these variables in detecting patients who may be contemplating suicide.Design of study: Cross-sectional analysis of older patients presenting to Australian GPs between 2002 and 2003. SETTING: One thousand and sixty-one consecutive patients aged 60 years or over attending one of 54 randomly selected Western Australian GPs. METHOD: Prior to their medical consultation, patients completed a self-report questionnaire, which included questions about current suicidal ideation (Depressive Symptom Inventory Suicidality Subscale [DSI-SS]) and depression (Center for Epidemiological Studies Depression Scale [CES-D]). Patients' chief complaints were obtained from consultation summary sheets completed by their GP. RESULTS: Although only 5.1% of patients presented with psychological complaints, 5.8% acknowledged current suicidal ideation and 23.8% had clinically significant levels of depressive symptomatology. Suicidal ideation was associated with CES-D scores greater than 16 (odds ratio [OR] = 3.7, 95% confidence interval [CI] = 1.5 to 8.9), feelings of depression (OR = 7.7, 95% CI = 3.4 to 17.7), and previous suicide attempt (OR = 7.4, 95% CI = 2.7 to 20.2) in a logistic regression model, but not with poor self-perceived health, use of licit drugs (smoking, alcohol, and hypnotics), or type of presenting complaint at the time of assessment. CONCLUSIONS: Although older general practice patients tend to present for issues related to their physical health, approximately a quarter of this cohort also possess high levels of psychological distress, including current thoughts of suicide. Older patients who show any signs of depression or distress should be asked about psychological symptoms, including suicidal ideation.     

Associations between sleep disturbances,mental health outcomes and burnout in firefighters,and the mediating role of sleep during overnight work: A cross‐sectional study

This study investigated whether sleep disorder risk and mental health outcomes in firefighters were associated with burnout, particularly emotional exhaustion, and examined the mediating role of sleep at work in these relationships. A secondary aim was to investigate associations between habitual sleep characteristics and burnout. North American firefighters (n = 6,307) completed the Maslach Burnout Inventory (emotional exhaustion, depersonalisation, personal accomplishment), and were screened for sleep disorders and self‐reported current mental health conditions and sleep characteristics. Multiple logistic regression analyses examined associations between sleep, mental health outcomes and burnout. Firefighters screening positive for a sleep disorder, particularly insomnia, had increased risk of emotional exhaustion (adjusted odds ratio 3.78, 95% confidence interval 2.97–4.79). Firefighters self‐reporting a current mental health condition were at greater risk of emotional exhaustion (adjusted odds ratio 3.45, 95% confidence interval 2.79–4.27). Sleep during overnight work mediated the impact of having a sleep disorder and mental health condition on high burnout. Sleepiness and sleep deficit (difference between required and actual sleep), even in firefighters without sleep disorder risk, were associated with depersonalisation (adjusted odds ratio 1.65, 95% confidence interval 1.34–2.03 and adjusted odds ratio 1.29, 95% confidence interval 1.06–1.57, respectively) and low personal accomplishment (adjusted odds ratio 1.25, 95% confidence interval 1.07–1.47 and adjusted odds ratio 1.17, 95% confidence interval 1.01–1.35, respectively). Sleep and mental health problems were associated with increased risk of burnout in firefighters, and sleep during overnight work mediated these relationships. The results suggest the need to examine the effectiveness of occupational interventions that improve the opportunity for sleep, together with screening for and treating sleep disorders, to reduce burnout risk.