Clinical burnout is one of the leading causes of work absenteeism in high- and middle-income coun... more Clinical burnout is one of the leading causes of work absenteeism in high- and middle-income countries. There is hence a great need for the identification of effective intervention strategies to increase return-to-work (RTW) in this population. This review aimed to assess the effectiveness of tertiary interventions for individuals with clinically significant burnout on RTW and psychological symptoms of exhaustion, depression and anxiety. Four electronic databases (Ovid MEDLINE, PsychINFO, PubMed and CINAHL Plus) were searched in April 2016 for randomized and non-randomized controlled trials of tertiary interventions in clinical burnout. Article screening and data extraction were conducted independently by two reviewers. Pooled odds ratios (ORs) and hazard ratios (HRs) were estimated with random-effects meta-analyses. Eight articles met the inclusion criteria. There was some evidence of publication bias. Included trials were of variable methodological quality. A significant effect of...
International Archives of Occupational and Environmental Health, 1999
To give an overview of an economic crisis in Sweden and its health consequences for employed and ... more To give an overview of an economic crisis in Sweden and its health consequences for employed and unemployed groups together with some health-related data from participants in labour market programmes. During the first half of the 1990's, Sweden was hit by a pervasive crises characterised by steeply increasing unemployment and growing job insecurity. Long-term survey data show that somatic well-being continued to improve in the population, while psychological well-being deteriorated, and this deterioration was of a similar magnitude among unemployed and employed groups. Two non-traditional labour market programmes for unemployed individuals are briefly described. Both programmes resulted in some positive effects on subjective health, which, however, were not corroborated by psychophysiological data. It is argued that the employment-unemployment dichotomy can be replaced by a dimensional view on labour market connection, as insecure jobs may have as detrimental health effects as open unemployment. Impediments to empowerment in the labour market programmes are discussed.
Integrative Physiological and Behavioral Science, 1999
The study examined psychosocial work-conditions and physiological reactions among thirty-six poli... more The study examined psychosocial work-conditions and physiological reactions among thirty-six police inspectors (median age 45 years, 81% males) who participated in a reorganization. At this time, subjects were threatened by unemployment and had to re-apply for their positions in a new police district. Data were collected during the reorganization and at three years follow-up, by means of questionnaires (Stress Profile) and blood samples. The blood samples were used to determine serum levels of gamma-glutamyltransferase (GGT), glucose, lipids, prolactin, testosterone and cortisol. The results show a positive association between worry about employment and symptoms of burnout during the reorganization. Mean scores for the Stress Profile sub-scales worry about employment (p<.01) and work-load (p<.05) decreased between measurements, but an impairment in relationships with management was noticed (p<.05). No significant changes were observed in terms of self-rated health complaints. Significant decreases in total cholesterol (p<.0001), LDL-cholesterol (p<.0001), LDL/HDL-ratio (p<.01), prolactin (p<.0001), as well as increases in testosterone (p<.01) and cortisol (p<.001) were observed for the whole sample. Glucose decreased with marginal significance (<.07). Controlling for age and gender, multivariate regression analyses showed that subjects who reported deteriorations in satisfaction with work manifested the most modest decreases in prolactin (p<.05). Also, the decrease in glucose was larger for subjects who experienced impairments in satisfaction with work (p<.05), information (p<.05), task-oriented leadership, (p<.05), and respect and dignity (p<.05). Subjects who perceived deteriorations in the ethical and moral standards of the organization increased their cortisol level to a lower degree than their counterparts (p<.05). Favorable changes in employment status and psychosocial work environment seem to be related to improved physiological functioning.
... Därigenom kan vi förhindra utslagningen av ett stort antal kvinnor som arbetar i den offentli... more ... Därigenom kan vi förhindra utslagningen av ett stort antal kvinnor som arbetar i den offentliga sektorn. ... för psykosocial miljömedicin, Stockholm Giorgio Grossi, fil dr i psykologi, stressmottagningen, Institutet för psykosocial miljömedicin, Stockholm Birgitta Evengård, ...
This cross-sectional investigation aimed at assessing levels of emotional exhaustion among female... more This cross-sectional investigation aimed at assessing levels of emotional exhaustion among female employees within the Swedish public sector. Other aims were to study the associations between self-rated emotional exhaustion and psychosocial factors at work, as well as findings from medical examinations. Data was collected by means of questionnaires including the Maslach Burnout Inventory, among 183 women working in geriatric care and 143 employees at the National Social Insurance Office. We found high proportions of emotional exhaustion in both samples (geriatric care = 34%; Social Insurance Office = 26%). Participants with high scores for emotional exhaustion reported more job-strain, less social support at work and more somatic, emotional and cognitive complaints than those with low or intermediate scores. Medical examinations performed on 19 participants with low scores and 41 with high scores for emotional exhaustion revealed significantly more findings among participants with high emotional exhaustion, particularly fatigue, sleep disturbances and cognitive impairment. There were no group differences in terms of depression or other findings. This study shows that individuals at risk for stress-related disorders may be identified using simple questionnaires. Early interventions for stress in the workplace may prevent incapacitating conditions among a great proportion of women working in the public sector.
The aim of this paper was to provide an overview of the literature on clinically significant burn... more The aim of this paper was to provide an overview of the literature on clinically significant burnout, focusing on its assessment, associations with sleep disturbances, cognitive impairments, as well as neurobiological and physiological correlates. Fifty-nine English language articles and six book chapters were included. The results indicate that exhaustion disorder (ED), as described in the Swedish version of the International Classification of Diseases, seems to be the most valid clinical equivalent of burnout. The data supports the notion that sleep impairments are causative and maintaining factors for this condition. Patients with clinical burnout/ED suffer from cognitive impairments in the areas of memory and executive functioning. The studies on neuro-biological mechanisms have reported functional uncoupling of networks relating the limbic system to the pre-frontal cortex, and decreased volumes of structures within the basal ganglia. Although there is a growing body of literatu...
This cross-sectional investigation aimed at assessing levels of emotional exhaustion among female... more This cross-sectional investigation aimed at assessing levels of emotional exhaustion among female employees within the Swedish public sector. Other aims were to study the associations between self-rated emotional exhaustion and psychosocial factors at work, as well as findings from medical examinations. Data was collected by means of questionnaires including the Maslach Burnout Inventory, among 183 women working in geriatric care and 143 employees at the National Social Insurance Office. We found high proportions of emotional exhaustion in both samples (geriatric care = 34%; Social Insurance Office = 26%). Participants with high scores for emotional exhaustion reported more job-strain, less social support at work and more somatic, emotional and cognitive complaints than those with low or intermediate scores. Medical examinations performed on 19 participants with low scores and 41 with high scores for emotional exhaustion revealed significantly more findings among participants with h...
International archives of occupational and environmental health, 1999
To give an overview of an economic crisis in Sweden and its health consequences for employed and ... more To give an overview of an economic crisis in Sweden and its health consequences for employed and unemployed groups together with some health-related data from participants in labour market programmes. During the first half of the 1990's, Sweden was hit by a pervasive crises characterised by steeply increasing unemployment and growing job insecurity. Long-term survey data show that somatic well-being continued to improve in the population, while psychological well-being deteriorated, and this deterioration was of a similar magnitude among unemployed and employed groups. Two non-traditional labour market programmes for unemployed individuals are briefly described. Both programmes resulted in some positive effects on subjective health, which, however, were not corroborated by psychophysiological data. It is argued that the employment-unemployment dichotomy can be replaced by a dimensional view on labour market connection, as insecure jobs may have as detrimental health effects as o...
Background: Insomnia-type sleep disturbances are frequent among patients suffering from stress-re... more Background: Insomnia-type sleep disturbances are frequent among patients suffering from stress-related exhaustion disorder. However, clinical observations indicate that a subgroup suffer from sleep lengths frequently exceeding 9 hours, coupled with great daytime sleepiness. Aims: The aim of the present study was to investigate differences in socio-demographic variables, use of medications, sleep parameters, anxiety, depression and fatigue, between individuals with varying sleep lengths, in a sample of 420 Swedish patients (mean age 42 ± 9 years; 77% women) referred to treatment for exhaustion disorder. Patients were allocated to the groups: "never/seldom ≥ 9 hours" (n = 248), "sometimes ≥ 9 hours" (n = 115) and "mostly/always ≥ 9 hours" (n = 57), based on their self-rated frequency of sleep lengths ≥ 9 hours. Methods: The design was cross-sectional and data was collected by means of questionnaires at pre-treatment. Results: Univariate analyses showed that patients in the "mostly/always ≥ 9 hours" group were more often on sick leave, and reported more depression and fatigue, better sleep quality and more daytime sleepiness, than patients in the other groups. Multivariate analyses showed that these patients scored higher on measures of fatigue than the rest of the sample independently of gender, use of antidepressants, sick leave, depression and quality of sleep. Conclusions: Patients suffering from exhaustion disorder and reporting excessive sleep seem to have a generally poorer clinical picture but better quality of sleep than their…
ABSTRACT We explored differences regarding several psychosocial constructs (e.g. coping with pain... more ABSTRACT We explored differences regarding several psychosocial constructs (e.g. coping with pain) between immigrant (n = 140) and Swedish (n = 446) patients seeking treatment for pain at health and physiotherapy centres. A cross‐sectional study design was used. The findings showed that, compared with Swedes, immigrants more often relied on benefits for their support and were more concerned with their financial situation. They also had longer periods of sick‐leave. In addition, immigrants felt more disabled, reported more job strain and relied more on passive coping strategies for pain. Finally, they were more emotionally distressed, as they showed more symptoms of burnout, anxiety, depression and post‐traumatic stress reactions, and lower self‐confidence. Multivariate analyses performed separately for immigrant and Swedish patients showed differential patterns of associations between sociodemographic variables, financial strain, emotional distress, perceived disability, passive coping and job strain. We conclude that immigrant patients live under more strained psychosocial conditions and experience a deeper impact of pain than do their Swedish counterparts.
... Gloria Macassa and Andres Fandino-Losada ... Others found that men exposed to violent crime r... more ... Gloria Macassa and Andres Fandino-Losada ... Others found that men exposed to violent crime received positive social support and were satisfied with it (Andrews, Brewin, & Rose, 2003); others report both low levels of perceived social support and high levels of received support ...
Scandinavian Journal of Occupational Therapy, 2002
ABSTRACT We evaluated the effects of educational (EI) and behavioural interventions (BI) across a... more ABSTRACT We evaluated the effects of educational (EI) and behavioural interventions (BI) across a 10-week treatment period and at 6-month follow-up on various variables (e.g. coping with pain) for female patients with fibromyalgia (FM). The effects of EI and BI vs. the waiting-list control (WLC) group were also analysed. The EI did not lead to any significant changes. The BI led to benefits on the patients' use of pain coping strategies, functional disability, perceptions of pain and quality of sleep. With the exception of quality of sleep, these effects disappeared at follow-up. The WLC deteriorated in some of the Coping Strategies Questionnaire (CSQ) and the McGill Pain Questionnaire (MPQ) subscales. The BI did somewhat better than the EI, in particular, but only the improvement in sleep-quality remained over time. We concluded that improvements were few after treatment and all, but one, disappeared at follow-up. Essentially, there were no differences between the three conditions in terms of effectiveness. More research is needed to clarify further the value of behaviourally oriented interventions for FM patients, particularly their value over time.
Clinical burnout is one of the leading causes of work absenteeism in high- and middle-income coun... more Clinical burnout is one of the leading causes of work absenteeism in high- and middle-income countries. There is hence a great need for the identification of effective intervention strategies to increase return-to-work (RTW) in this population. This review aimed to assess the effectiveness of tertiary interventions for individuals with clinically significant burnout on RTW and psychological symptoms of exhaustion, depression and anxiety. Four electronic databases (Ovid MEDLINE, PsychINFO, PubMed and CINAHL Plus) were searched in April 2016 for randomized and non-randomized controlled trials of tertiary interventions in clinical burnout. Article screening and data extraction were conducted independently by two reviewers. Pooled odds ratios (ORs) and hazard ratios (HRs) were estimated with random-effects meta-analyses. Eight articles met the inclusion criteria. There was some evidence of publication bias. Included trials were of variable methodological quality. A significant effect of...
International Archives of Occupational and Environmental Health, 1999
To give an overview of an economic crisis in Sweden and its health consequences for employed and ... more To give an overview of an economic crisis in Sweden and its health consequences for employed and unemployed groups together with some health-related data from participants in labour market programmes. During the first half of the 1990's, Sweden was hit by a pervasive crises characterised by steeply increasing unemployment and growing job insecurity. Long-term survey data show that somatic well-being continued to improve in the population, while psychological well-being deteriorated, and this deterioration was of a similar magnitude among unemployed and employed groups. Two non-traditional labour market programmes for unemployed individuals are briefly described. Both programmes resulted in some positive effects on subjective health, which, however, were not corroborated by psychophysiological data. It is argued that the employment-unemployment dichotomy can be replaced by a dimensional view on labour market connection, as insecure jobs may have as detrimental health effects as open unemployment. Impediments to empowerment in the labour market programmes are discussed.
Integrative Physiological and Behavioral Science, 1999
The study examined psychosocial work-conditions and physiological reactions among thirty-six poli... more The study examined psychosocial work-conditions and physiological reactions among thirty-six police inspectors (median age 45 years, 81% males) who participated in a reorganization. At this time, subjects were threatened by unemployment and had to re-apply for their positions in a new police district. Data were collected during the reorganization and at three years follow-up, by means of questionnaires (Stress Profile) and blood samples. The blood samples were used to determine serum levels of gamma-glutamyltransferase (GGT), glucose, lipids, prolactin, testosterone and cortisol. The results show a positive association between worry about employment and symptoms of burnout during the reorganization. Mean scores for the Stress Profile sub-scales worry about employment (p<.01) and work-load (p<.05) decreased between measurements, but an impairment in relationships with management was noticed (p<.05). No significant changes were observed in terms of self-rated health complaints. Significant decreases in total cholesterol (p<.0001), LDL-cholesterol (p<.0001), LDL/HDL-ratio (p<.01), prolactin (p<.0001), as well as increases in testosterone (p<.01) and cortisol (p<.001) were observed for the whole sample. Glucose decreased with marginal significance (<.07). Controlling for age and gender, multivariate regression analyses showed that subjects who reported deteriorations in satisfaction with work manifested the most modest decreases in prolactin (p<.05). Also, the decrease in glucose was larger for subjects who experienced impairments in satisfaction with work (p<.05), information (p<.05), task-oriented leadership, (p<.05), and respect and dignity (p<.05). Subjects who perceived deteriorations in the ethical and moral standards of the organization increased their cortisol level to a lower degree than their counterparts (p<.05). Favorable changes in employment status and psychosocial work environment seem to be related to improved physiological functioning.
... Därigenom kan vi förhindra utslagningen av ett stort antal kvinnor som arbetar i den offentli... more ... Därigenom kan vi förhindra utslagningen av ett stort antal kvinnor som arbetar i den offentliga sektorn. ... för psykosocial miljömedicin, Stockholm Giorgio Grossi, fil dr i psykologi, stressmottagningen, Institutet för psykosocial miljömedicin, Stockholm Birgitta Evengård, ...
This cross-sectional investigation aimed at assessing levels of emotional exhaustion among female... more This cross-sectional investigation aimed at assessing levels of emotional exhaustion among female employees within the Swedish public sector. Other aims were to study the associations between self-rated emotional exhaustion and psychosocial factors at work, as well as findings from medical examinations. Data was collected by means of questionnaires including the Maslach Burnout Inventory, among 183 women working in geriatric care and 143 employees at the National Social Insurance Office. We found high proportions of emotional exhaustion in both samples (geriatric care = 34%; Social Insurance Office = 26%). Participants with high scores for emotional exhaustion reported more job-strain, less social support at work and more somatic, emotional and cognitive complaints than those with low or intermediate scores. Medical examinations performed on 19 participants with low scores and 41 with high scores for emotional exhaustion revealed significantly more findings among participants with high emotional exhaustion, particularly fatigue, sleep disturbances and cognitive impairment. There were no group differences in terms of depression or other findings. This study shows that individuals at risk for stress-related disorders may be identified using simple questionnaires. Early interventions for stress in the workplace may prevent incapacitating conditions among a great proportion of women working in the public sector.
The aim of this paper was to provide an overview of the literature on clinically significant burn... more The aim of this paper was to provide an overview of the literature on clinically significant burnout, focusing on its assessment, associations with sleep disturbances, cognitive impairments, as well as neurobiological and physiological correlates. Fifty-nine English language articles and six book chapters were included. The results indicate that exhaustion disorder (ED), as described in the Swedish version of the International Classification of Diseases, seems to be the most valid clinical equivalent of burnout. The data supports the notion that sleep impairments are causative and maintaining factors for this condition. Patients with clinical burnout/ED suffer from cognitive impairments in the areas of memory and executive functioning. The studies on neuro-biological mechanisms have reported functional uncoupling of networks relating the limbic system to the pre-frontal cortex, and decreased volumes of structures within the basal ganglia. Although there is a growing body of literatu...
This cross-sectional investigation aimed at assessing levels of emotional exhaustion among female... more This cross-sectional investigation aimed at assessing levels of emotional exhaustion among female employees within the Swedish public sector. Other aims were to study the associations between self-rated emotional exhaustion and psychosocial factors at work, as well as findings from medical examinations. Data was collected by means of questionnaires including the Maslach Burnout Inventory, among 183 women working in geriatric care and 143 employees at the National Social Insurance Office. We found high proportions of emotional exhaustion in both samples (geriatric care = 34%; Social Insurance Office = 26%). Participants with high scores for emotional exhaustion reported more job-strain, less social support at work and more somatic, emotional and cognitive complaints than those with low or intermediate scores. Medical examinations performed on 19 participants with low scores and 41 with high scores for emotional exhaustion revealed significantly more findings among participants with h...
International archives of occupational and environmental health, 1999
To give an overview of an economic crisis in Sweden and its health consequences for employed and ... more To give an overview of an economic crisis in Sweden and its health consequences for employed and unemployed groups together with some health-related data from participants in labour market programmes. During the first half of the 1990's, Sweden was hit by a pervasive crises characterised by steeply increasing unemployment and growing job insecurity. Long-term survey data show that somatic well-being continued to improve in the population, while psychological well-being deteriorated, and this deterioration was of a similar magnitude among unemployed and employed groups. Two non-traditional labour market programmes for unemployed individuals are briefly described. Both programmes resulted in some positive effects on subjective health, which, however, were not corroborated by psychophysiological data. It is argued that the employment-unemployment dichotomy can be replaced by a dimensional view on labour market connection, as insecure jobs may have as detrimental health effects as o...
Background: Insomnia-type sleep disturbances are frequent among patients suffering from stress-re... more Background: Insomnia-type sleep disturbances are frequent among patients suffering from stress-related exhaustion disorder. However, clinical observations indicate that a subgroup suffer from sleep lengths frequently exceeding 9 hours, coupled with great daytime sleepiness. Aims: The aim of the present study was to investigate differences in socio-demographic variables, use of medications, sleep parameters, anxiety, depression and fatigue, between individuals with varying sleep lengths, in a sample of 420 Swedish patients (mean age 42 ± 9 years; 77% women) referred to treatment for exhaustion disorder. Patients were allocated to the groups: "never/seldom ≥ 9 hours" (n = 248), "sometimes ≥ 9 hours" (n = 115) and "mostly/always ≥ 9 hours" (n = 57), based on their self-rated frequency of sleep lengths ≥ 9 hours. Methods: The design was cross-sectional and data was collected by means of questionnaires at pre-treatment. Results: Univariate analyses showed that patients in the "mostly/always ≥ 9 hours" group were more often on sick leave, and reported more depression and fatigue, better sleep quality and more daytime sleepiness, than patients in the other groups. Multivariate analyses showed that these patients scored higher on measures of fatigue than the rest of the sample independently of gender, use of antidepressants, sick leave, depression and quality of sleep. Conclusions: Patients suffering from exhaustion disorder and reporting excessive sleep seem to have a generally poorer clinical picture but better quality of sleep than their…
ABSTRACT We explored differences regarding several psychosocial constructs (e.g. coping with pain... more ABSTRACT We explored differences regarding several psychosocial constructs (e.g. coping with pain) between immigrant (n = 140) and Swedish (n = 446) patients seeking treatment for pain at health and physiotherapy centres. A cross‐sectional study design was used. The findings showed that, compared with Swedes, immigrants more often relied on benefits for their support and were more concerned with their financial situation. They also had longer periods of sick‐leave. In addition, immigrants felt more disabled, reported more job strain and relied more on passive coping strategies for pain. Finally, they were more emotionally distressed, as they showed more symptoms of burnout, anxiety, depression and post‐traumatic stress reactions, and lower self‐confidence. Multivariate analyses performed separately for immigrant and Swedish patients showed differential patterns of associations between sociodemographic variables, financial strain, emotional distress, perceived disability, passive coping and job strain. We conclude that immigrant patients live under more strained psychosocial conditions and experience a deeper impact of pain than do their Swedish counterparts.
... Gloria Macassa and Andres Fandino-Losada ... Others found that men exposed to violent crime r... more ... Gloria Macassa and Andres Fandino-Losada ... Others found that men exposed to violent crime received positive social support and were satisfied with it (Andrews, Brewin, & Rose, 2003); others report both low levels of perceived social support and high levels of received support ...
Scandinavian Journal of Occupational Therapy, 2002
ABSTRACT We evaluated the effects of educational (EI) and behavioural interventions (BI) across a... more ABSTRACT We evaluated the effects of educational (EI) and behavioural interventions (BI) across a 10-week treatment period and at 6-month follow-up on various variables (e.g. coping with pain) for female patients with fibromyalgia (FM). The effects of EI and BI vs. the waiting-list control (WLC) group were also analysed. The EI did not lead to any significant changes. The BI led to benefits on the patients' use of pain coping strategies, functional disability, perceptions of pain and quality of sleep. With the exception of quality of sleep, these effects disappeared at follow-up. The WLC deteriorated in some of the Coping Strategies Questionnaire (CSQ) and the McGill Pain Questionnaire (MPQ) subscales. The BI did somewhat better than the EI, in particular, but only the improvement in sleep-quality remained over time. We concluded that improvements were few after treatment and all, but one, disappeared at follow-up. Essentially, there were no differences between the three conditions in terms of effectiveness. More research is needed to clarify further the value of behaviourally oriented interventions for FM patients, particularly their value over time.
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Papers by Giorgio Grossi