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  • 1. Berglund, Linnea Hergot
    et al.
    Prytz, Hanne Sandberg
    Perski, Aleksander
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Svartberg, Johan
    Testosterone levels and psychological health status in men from a general population: the Troms circle divide o study2011In: The Aging Male, ISSN 1368-5538, E-ISSN 1473-0790, Vol. 14, no 1, p. 37-41Article in journal (Refereed)
    Abstract [en]

    Methods. aEuro integral Total testosterone and sex hormone-binding globulin levels were analysed and free testosterone levels was calculated in 3413 men participating in the fifth Troms circle divide o study in 2001. Self-administered questionnaires including information about education, marital status, smoking habits and the Hopkins Symptom Checklist-10 (SCL-10, a 10-item psychological health questionnaire) were completed. The cross-sectional data were analysed with partial association and analysis of variance and covariance. Results. aEuro integral The complete SCL-10 was not associated with total or free testosterone, but symptoms of anxiety were negatively associated with both total and free testosterone (p < 0.05). Men presumed to be testosterone deficient, with testosterone levels in the lowest 10th percentile, had increased SCL-10 score compared to men with higher testosterone levels (p == 0.021), before and after adjusting for age, waist circumference, marital status, education and smoking. There was an even stronger association between men presumed to be testosterone deficient and symptoms of anxiety (p < 0.001). However, men with more pronounced symptoms indicating mental disorder did not have lower testosterone levels. Conclusions. aEuro integral Men presumed being testosterone deficient had a higher symptom score, in particularly regarding anxiety, but they did not have pathological symptoms. Thus, lower testosterone levels was only associated with subthreshold symptoms of anxiety and depression.

  • 2. Blix, Eva
    et al.
    Perski, Aleksander
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Berglund, Hans
    Savic, Ivanka
    Long-Term Occupational Stress Is Associated with Regional Reductions in Brain Tissue Volumes2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 6, article id e64065Article in journal (Refereed)
    Abstract [en]

    There are increasing reports of cognitive and psychological declines related to occupational stress in subjects without psychiatric premorbidity or major life trauma. The underlying neurobiology is unknown, and many question the notion that the described disabilities represent a medical condition. Using PET we recently found that persons suffering from chronic occupational stress had limbic reductions in the 5-HT1A receptor binding potential. Here we examine whether chronic work-related stress is also associated with changes in brain structure. We performed MRI-based voxel-based morphometry and structural volumetry in stressed subjects and unstressed controls focusing on gray (GM) and white matter (WM) volumes, and the volumes of hippocampus, caudate, and putamen - structures known to be susceptible to neurotoxic changes. Stressed subjects exhibited significant reductions in the GM volumes of the anterior cingulate cortex and the dorsolateral prefrontal cortex. Furthermore, their caudate and putamen volumes were reduced, and the volumes correlated inversely to the degree of perceived stress. Our results add to previous data on chronic psychosocial stress, and indicate a morphological involvement of the frontostriatal circuits. The present findings of morphological changes in these regions confirm our previous conclusion that symptoms from occupational stress merit careful investigations and targeted treatment.

  • 3.
    Danielsson, Maria
    et al.
    Swedish National Board of Health and Welfare, Stockholm, Sweden.
    Heimerson, Inger
    Swedish National Board of Health and Welfare, Stockholm, Sweden.
    Lundberg, Ulf
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Perski, Aleksander
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Stefansson, Claes-Göran
    Swedish National Board of Health and Welfare, Stockholm, Sweden.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Psychosocial stress and health problems: Health in Sweden: The National Public Health Report 2012. Chapter 62012In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 40, no 9 suppl, p. 121-134Article in journal (Other academic)
    Abstract [en]

    Stress can be defined as an imbalance between demands placed on us and our ability to manage them. The body’s stress system is adapted to confront sudden physical threats. Today, however, we are increasingly exposed to prolonged mental and psychosocial stress. Prolonged stress can give rise to a range of problems: poor performance, chronic fatigue, disinterest, dejection, memory disturbances, sleep problems, numbness and diffuse muscle pains. These symptoms may eventually be followed by depression, post-traumatic stress disorder and chronic fatigue syndrome, and ultimately chronic pain conditions, cardiovascular disease and diabetes. Sleep is a vital counterbalance to stress as it enables the body to recover properly. Good sleep is thus essential to our ability to cope with stress and stay healthy.

    The decline in the mental wellbeing of the population since the 1980s has been accompanied by a rise in the number of pain complaints. A similar development in respect of symptoms such as anxiousness, nervousness and anxiety, constant fatigue and neck and shoulder pain and sleeping problems has been observed in the population. This increase, which continued throughout the 1990s and culminated in 2001, was followed by a slight fall. However, there was no decline among young people in the early 2000s. Rather, the number of complaints continued to increase.

    Since the mid-1990s, the proportion of people suffering from stress symptoms has risen and fallen in step with employment levels. Since the beginning of the 1980s, growing numbers of people in gainful employment have experienced their work as hectic and mentally taxing. This may indicate that the balance between healthy and unhealthy factors impacting the actively employed has tilted towards less favourable conditions. Mental stress at work has increased among women and men, particularly among county council employees. Repeated organisational restructuring may explain why hectic and mentally taxing work has become more commonplace. Mental ill-health along with musculoskeletal disorders are the most frequent diagnoses in connection with newly granted disability pensions. Sickness absence trends largely reflect the trend in stress symptoms.

  • 4. Golkar, Armita
    et al.
    Johansson, Emilia
    Kasahara, Maki
    Osika, Walter
    Perski, Aleksander
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Savic, Ivanka
    The Influence of Work-Related Chronic Stress on the Regulation of Emotion and on Functional Connectivity in the Brain2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 9, p. e104550-Article in journal (Refereed)
    Abstract [en]

    Despite mounting reports about the negative effects of chronic occupational stress on cognitive and emotional functions, the underlying mechanisms are unknown. Recent findings from structural MRI raise the question whether this condition could be associated with a functional uncoupling of the limbic networks and an impaired modulation of emotional stress. To address this, 40 subjects suffering from burnout symptoms attributed to chronic occupational stress and 70 controls were investigated using resting state functional MRI. The participants' ability to up-regulate, down-regulate, and maintain emotion was evaluated by recording their acoustic startle response while viewing neutral and negatively loaded images. Functional connectivity was calculated from amygdala seed regions, using explorative linear correlation analysis. Stressed subjects were less capable of down-regulating negative emotion, but had normal acoustic startle responses when asked to up-regulate or maintain emotion and when no regulation was required. The functional connectivity between the amygdala and the anterior cingulate cortex correlated with the ability to down-regulate negative emotion. This connectivity was significantly weaker in the burnout group, as was the amygdala connectivity with the dorsolateral prefrontal cortex and the motor cortex, whereas connectivity from the amygdala to the cerebellum and the insular cortex were stronger. In subjects suffering from chronic occupational stress, the functional couplings within the emotion-and stress-processing limbic networks seem to be altered, and associated with a reduced ability to down-regulate the response to emotional stress, providing a biological substrate for a further facilitation of the stress condition.

  • 5.
    Grossi, Giorgio
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. The Stress Clinic Foundation, Sweden.
    Jeding, Kerstin
    Söderström, Marie
    Osika, Walter
    Levander, Maria
    Perski, Aleksander
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. The Stress Clinic Foundation, Sweden.
    Self-reported sleep lengths ≥ 9 hours among Swedish patients with stress-related exhaustion: associations with depression, quality of sleep and levels of fatigue2015In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 69, no 4, p. 292-299Article in journal (Refereed)
    Abstract [en]

    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 counterparts with shorter sleep lengths. The mechanisms underlying these differences, together with their prognostic value and implications for treatment remain to be elucidated in future studies.

  • 6.
    Grossi, Giorgio
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. The Stress Clinic Foundation, Sweden; Karolinska institute, Sweden.
    Perski, Aleksander
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. The Stress Clinic Foundation, Sweden.
    Osika, Walter
    Savic, Ivanka
    Stress-related exhaustion disorder - clinical manifestation of burnout? A review of assessment methods, sleep impairments, cognitive disturbances, and neuro-biological and physiological changes in clinical burnout2015In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 56, no 6, p. 626-636Article in journal (Refereed)
    Abstract [en]

    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 literature on the physiological correlates of clinical burnout/ED, there is to date no biomarker for this condition. More studies on the role of sleep disturbances, cognitive impairments, and neurobiological and physiological correlates in clinical burnout/ED are warranted.

  • 7. Ishtiak-Ahmed, Kazi
    et al.
    Perski, Aleksander
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Mittendorfer-Rutz, Ellenor
    Predictors of suicidal behaviour in 36,304 individuals sickness absent due to stress-related mental disorders - a Swedish register linkage cohort study2013In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, p. 492-Article in journal (Refereed)
    Abstract [en]

    Background: Stress-related mental disorders (SRMD), which correspond to the diagnostic code F43 in the International Classification of Diseases, version 10, rank among the leading causes of sickness absence in several European countries. Despite the size of this health problem, research on risk factors for severe medical outcomes, like suicidal behavior, is lacking to date. The aim of this study was to investigate predictors of suicide attempt and suicide among sickness absentees with SRMD. Methods: A cohort of 36,304 non-retired individuals, aged 16-64 years on 31.12.2004, with at least one sickness absence spell due to SRMD, initiated in 2005, was followed up with regard to suicide attempt (2006-2009) and suicide (2006-2008). Univariate and multivariate hazard ratios (HR) with 95% confidence intervals (CI) were estimated for a number of predictors. Results: During the follow-up period, 266 individuals attempted suicide and 34 committed suicide. In the multivariate analyses, the following factors increased the risk of suicide attempt: =<25 years of age, low educational level, lone parenthood, > 1 sickness absence spell, long duration of the first spell of sickness absence due to SRMD (> 180 days), > 4 and > 8 days of inpatient care due to somatic or mental diagnoses (2000-2005), and > 4 and > 1 outpatient visits due to somatic or mental diagnoses (2001-2005), respectively. Hazard ratios ranged from 1.4 to 4.2. Health care due to mental diagnoses and > 1 spell of sickness absence regardless of diagnosis were predictive of suicide. Conclusions: Several predictors related to socio-demographics, sickness absence and health-care consumption were identified as risk factors for suicidal behavior. Consideration of these risk factors is of both clinical and public health importance.

  • 8. Ishtiak-Ahmed, Kazi
    et al.
    Perski, Aleksander
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Mittendorfer-Rutz, Ellenor
    Risk markers of all-cause and diagnosis-specific disability pension - a prospective cohort study of individuals sickness absent due to stress-related mental disorders2014In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, p. 805-Article in journal (Refereed)
    Abstract [en]

    Background: Stress-related mental disorders rank among the leading causes of sickness absence in several European countries. The aim of this study was to investigate predictors of all-cause and diagnosis-specific disability pension in sickness absentees with stress-related mental disorders. Methods: A cohort of 36304 non-retired individuals aged 16-64 years at 31.12.2004 with at-least one sickness absence spell due to stress-related mental disorders (SRMD) initiated in 2005 in Sweden was followed-up with regard to disability pension (2006-2010) by linkage of registers. Uni- and multivariate Hazard ratios (HR) with 95% Confidence Intervals, CI, were estimated using Cox regression for several risk markers. Results: During the follow-up period, 2735 individuals (7.5%) were granted a disability pension, predominantly due to mental diagnoses (n = 2004, 73.3%). In the multivariate analyses, female sex, age exceeding 35 years, low educational level, being born in a country outside EU25 and Northern Europe, residing outside big cities, living alone, having had a long duration of the first spell due to SRMD (>90 days); mental disorders necessitating frequent specialised health care as well as comorbid somatic disorders were found to be predictive of granting disability pension. Some different patterns emerged for risk factors related to diagnosis-specific disability pension and for younger and older individuals. Conclusions: Several predictors could be identified as risk markers for disability pension. The variation in the effect of risk markers with regard to age and diagnosis of disability pension speaks in favour of the importance of a person-centered approach in treatment and rehabilitation.

  • 9. Jovanovic, H.
    et al.
    Perski, Aleksander
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Berglund, H.
    Savic, I.
    Chronic stress is linked to 5-HT(1A) receptor changes and functional disintegration of the limbic networks.2011In: NeuroImage, ISSN 1053-8119, E-ISSN 1095-9572, Vol. 55, no 3, p. 1178-88Article in journal (Refereed)
    Abstract [en]

    There are increasing reports about stress related cognitive and psychic declines in subjects who have no psychiatric premorbidity, depression, or major life trauma. Yet, little is known about the underlying neurobiology. Based on the typical symptomatology, fMRI data suggesting that stress activates the limbic circuits, and animal data showing a major involvement of the 5-HT(1A) receptor in stress regulation, we hypothesized that enduring daily stress causes widespread limbic dysfunctions, and specific changes of the 5-HT(1A) receptor. To test these hypotheses combined PET studies were carried out in 16 chronically stressed, and 16 non-stressed subjects. Limbic function was tested by measuring cerebral blood flow during rest, and when using an odor activation paradigm. 5-HT(1A) receptor binding potential (BP) was assessed with [(11)C]WAY100635. All subjects went through a battery of neuropsychological tests. Stressed subjects showed a functional disconnection between the amygdala and ACC/medial prefrontal cortex (mPFC), and an impaired odor activation of the ACC. They also displayed a reduced 5-HT(1A) receptor BP in the anterior cingulate (ACC), the insular-cortex, and the hippocampus. Their performance in attention-, odor discrimination-, and semantic memory tasks was impaired, and correlated with the BP-values in the respective region. The degree of reported stress was inversely correlated with activation of ACC, and the 5-HT(1A) receptor BP in the amygdala and hippocampus. Enduring every day psychosocial stress seems to be associated with a limbic reduction of 5-HT(1A) receptor binding and functional disintegration of ACC/mPFC. These changes support the notion of an impaired top-down regulation of stress stimuli, and identify potential targets for early treatment.

  • 10. Mittendorfer-Rutz, Ellenor
    et al.
    Kjeldgård, Linnea
    Runeson, Bo
    Perski, Aleksander
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Melchior, Maria
    Head, Jenny
    Alexanderson, Kristina
    Sickness Absence Due to Specific Mental Diagnoses and All-Cause and Cause-Specific Mortality: A Cohort Study of 4.9 Million Inhabitants of Sweden2012In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 9, article id e45788Article in journal (Refereed)
    Abstract [en]

    Background: Despite the magnitude and increase of sickness absence due to mental diagnoses, little is known regarding long-term health outcomes. The aim of this nationwide population-based, prospective cohort study was to investigate the association between sickness absence due to specific mental diagnoses and the risk of all-cause and cause-specific mortality. Methods: A cohort of all 4 857 943 individuals living in Sweden on 31.12.2004 (aged 16-64 years, not sickness absent, or on retirement or disability pension), was followed from 01.01.2005 through 31.12.2008 for all-cause and cause-specific mortality (suicide, cancer, circulatory disease) through linkage of individual register data. Individuals with at least one new sick-leave spell with a mental diagnosis in 2005 were compared to individuals with no sickness absence. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated by Cox regression, adjusting for age, sex, education, country of birth, family situation, area of residence, and pre-existing morbidity (diagnosis-specific hospital inpatient (2000-2005) and outpatient (2001-2005) care). Results: In the multivariate analyses, mental sickness absence in 2005 was associated with an increased risk for all-cause mortality: HR: 1.65, 95% CI: 1.47-1.86 in women and in men: 1.73, 1.57-1.91; for suicide, cancer (both smoking and nonsmoking related) as well as mortality due to circulatory disease only in men. Estimates for cause-specific mortality ranged from 1.48 to 3.37. Associations with all-cause mortality were found for all mental sickness absence diagnostic groups studied. Conclusions: Knowledge about the prognosis of patients sickness absent with specific mental diagnoses is of crucial clinical importance in health care. Sickness absence due to specific mental diagnoses may here be used as a risk indictor for subsequent mortality.

  • 11. Orth-Gomér, Kristina
    et al.
    Perski, AleksanderStockholm University, Faculty of Social Sciences, Stress Research Institute.
    Preventiv medicin: Teori och praktik2008Collection (editor) (Other (popular science, discussion, etc.))
  • 12.
    Perski, Aleksander
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Interview with Töres Theorell.: After 30 years with the demand-control-support model – hos is it used today?2008In: SJWEH Suppl 2008;(6):7-17, ISSN 1795-9926Article in journal (Other (popular science, discussion, etc.))
  • 13.
    Perski, Aleksander
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Om stress, utbrändhet och vägar tillbaka till hälsa2012In: Psykosocial miljö och stress / [ed] Töres Theorell, Lund: Studentlitteratur , 2012, 2, p. 120-131Chapter in book (Other academic)
  • 14.
    Perski, Aleksander
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Jeding, Kerstin
    Att motverka kronisk stress och utbrändhet2008In: Preventiv medicin: Teori och praktik, Studentlitteratur, Lund , 2008, p. 93-114Chapter in book (Other academic)
  • 15.
    Perski, Aleksander
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Osika, Walter
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Det stressade hjärtat2012 (ed. 2)Book (Other academic)
  • 16. Ristiniemi, Heli
    et al.
    Perski, Aleksander
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Lyskov, Eugene
    Emtner, Margareta
    Hyperventilation and exhaustion syndrome2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 4, p. 657-664Article in journal (Refereed)
    Abstract [en]

    Chronic stress is among the most common diagnoses in Sweden, most commonly in the form of exhaustion syndrome (ICD-10 classification - F43.8). The majority of patients with this syndrome also have disturbed breathing (hyperventilation). The aim of this study was to investigate the association between hyperventilation and exhaustion syndrome. Thirty patients with exhaustion syndrome and 14 healthy subjects were evaluated with the Nijmegen Symptom Questionnaire (NQ). The participants completed questionnaires about exhaustion, mental state, sleep disturbance, pain and quality of life. The evaluation was repeated 4 weeks later, after half of the patients and healthy subjects had engaged in a therapy method called 'Grounding', a physical exercise inspired by African dance. The patients reported significantly higher levels of hyperventilation as compared to the healthy subjects. All patients' average score on NQ was 26.57 ± 10.98, while that of the healthy subjects was 15.14 ± 7.89 (t = -3.48, df = 42, p < 0.001). The NQ scores correlated strongly with two measures of exhaustion (Karolinska Exhaustion Scale KES r = 0.772, p < 0.01; Shirom Melamed Burnout Measure SMBM r = 0.565, p < 0.01), mental status [Hospital Anxiety and Depression Score (HADS) depression r = 0.414, p < 0.01; HADS anxiety r = 0.627, p < 0.01], sleep disturbances (r = -0.514, p < 0.01), pain (r = -.370, p < 0.05) and poor well-being (Medical Outcomes Survey Short Form 36 questionnaire- SR Health r = -0.529, p < 0.05). In the logistic regression analysis, the variance in the scores from NQ were explained to a high degree (R(2)  = 0.752) by scores in KES and HADS. The brief Grounding training contributed to a near significant reduction in hyperventilation (F = 2.521, p < 0.124) and to significant reductions in exhaustion scores and scores of depression and anxiety. The conclusion is that hyperventilation is common in exhaustion syndrome patients and that it can be reduced by systematic physical therapy such as Grounding.

  • 17. Rose, Johanna
    et al.
    Perski, Aleksander
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Duktighetsfällan – en överlevnadshandbok för prestationsprinsessor2008Book (Other (popular science, discussion, etc.))
  • 18.
    Saboonchi, Fredrik
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Red Cross University College, Sweden; Karolinska Institutet, Sweden.
    Perski, Aleksander
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Grossi, Giorgio
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Validation of Karolinska Exhaustion Scale: psychometric properties of a measure of exhaustion syndrome2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 4, p. 1010-1017Article in journal (Refereed)
    Abstract [en]

    Background The syndrome of exhaustion is currently a medical diagnosis in Sweden. The description of the syndrome largely corresponds to the suggested core component of burnout, that is exhaustion. Karolinska Exhaustion Scale (KES) has been constructed to provide specific assessment of exhaustion in clinical and research settings.

    Aim The purpose of the present study was to examine the psychometric properties of this scale in its original and revised versions by examining the factorial structure and measures of convergent and discriminant validity.

    Methods Data gathered from two independent samples (n1 = 358 & n2 = 403) consisting of patients diagnosed with 'reaction to severe stress, and adjustment disorder' were subjected to confirmatory factor analysis. The study's instruments were Karolinska Exhaustion Scale and Shirom Melam Burnout Measure. Correlation analyses were employed to follow up the established factorial structure of the scale. The study was ethically approved by Karolinska Institute regional ethic committee.

    Results The findings demonstrated adequate fit of the data to the measurement model provided by the revised version of KES Limitations: The main limitation of the present study is the lack of a gold standard of exhaustion for direct comparison with KES. (KES-26) and partially supported convergent validity and discriminant validity of the scale.

    Conclusion The demonstrated psychometric properties of KES-26 indicate sound construct validity for this scale encouraging use of this scale in assessment of exhaustion. The factorial structure of KES-26 may also be used to provide information concerning possible different clinical profiles.

  • 19.
    Schraml, Karin
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Perski, Aleksander
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Grossi, Giorgio
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Makower, Irena
    Chronic stress and its consequences on subsequent academic achievement among adolescents2012In: Journal of Educational and Developmental Psychology, ISSN 1927-0534, Vol. 2, no 1, p. 69-79Article in journal (Refereed)
    Abstract [en]

    Chronic stress has been associated with severe stress-related symptoms not only among adults but also among adolescents. The aim of the study was to investigate if chronic stress has implications for adolescents’ academic achievement. 270 high school students answered a questionnaire on stress symptoms on two occasions, at the beginning and at the end of high school. Those who perceived severe stress symptoms at both time points finished high school with significantly worse final grades than those who reported experiencing stress at only one or none of the time points. The risk for chronic stress was increased among adolescents with low global self-esteem, who perceived high demands and reported their self-rated health to be poor and their sleep duration to be insufficient. The results suggest that the early prevention of chronic stress is critical since, if left untreated, it can have serious consequences on young people’s future health and career possibilities.

  • 20.
    Schraml, Karin
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Perski, Alexander
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Grossi, Georgio
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Simonsson-Sarnecki, Margareta
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Stress symptoms among adolescents: The role of subjective psychosocial conditions, lifestyle, and self-esteem2011In: Journal of Adolescence, ISSN 0140-1971, E-ISSN 1095-9254, Vol. 34, no 5, p. 987-996Article in journal (Refereed)
    Abstract [en]

    Stress-related problems are increasing among Swedish adolescents, especially among females. The aims of this study were to survey the incidence of stress symptoms among 16-year-olds, to investigate the related gender differences, and to understand the factors that may contribute to stress symptoms. The study is questionnaire based, and the sample included 304 first-year high school students from two comparable schools. More than 30% of the high school students reported serious stress symptoms. Almost every second girl and every fifth boy reported that they felt stressed to a high degree. 8.2% were found to have severe stress symptoms, which would be considered a sign of chronic stress in adults. Besides the perception of high demands, low levels of global self-esteem, sleep disturbances, and poor social support played a crucial role in the prediction of stress symptoms. The findings highlight the need to develop and implement adequate stress prevention measures for adolescents.

  • 21.
    Schraml, Karin
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Schwarz, Johanna
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Perski, Aleksander
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    The role of social jetlag and stress in academic achievement among adolescentsArticle in journal (Refereed)
  • 22. Söderström, Marie
    et al.
    Jeding, Kerstin
    Ekstedt, Mirjam
    Perski, Aleksander
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Insufficient Sleep Predicts Clinical Burnout2012In: Journal of Occupational Health Psychology, ISSN 1076-8998, E-ISSN 1939-1307, Vol. 17, no 2, p. 175-183Article in journal (Refereed)
    Abstract [en]

    The present prospective study aimed to identify risk factors for subsequent clinical burnout. Three hundred eighty-eight working individuals completed a baseline questionnaire regarding work stress, sleep, mood, health, and so forth. During a 2-year period, 15 subjects (7 women and 8 men) of the total sample were identified as "burnout cases," as they were assessed and referred to treatment for clinical burnout. Questionnaire data from the baseline measurement were used as independent variables in a series of logistic regression analyses to predict clinical burnout. The results identified "too little sleep (< 6 h)" as the main risk factor for burnout development, with adjustment for "work demands," "thoughts of work during leisure time," and "sleep quality." The first two factors were significant predictors in earlier steps of the multivariate regression. The results indicate that insufficient sleep, preoccupation with thoughts of work during leisure time, and high work demands are risk factors for subsequent burnout. The results suggest a chain of causation.

  • 23. Wang, Mo
    et al.
    Alexanderson, Kristina
    Runeson, Bo
    Head, Jenny
    Melchior, Maria
    Perski, Aleksander
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Mittendorfer-Rutz, Ellenor
    Are all-cause and diagnosis-specific sickness absence, and sick-leave duration risk indicators for suicidal behaviour? A nationwide register-based cohort study of 4.9 million inhabitants of Sweden2014In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 71, no 1, p. 12-20Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Recent studies have found an increased risk of suicide in people on sickness absence, but less is known about to what extent diagnosis-specific sickness absence is a risk indicator for suicidal behaviour. This study aimed to examine all-cause and diagnosis-specific sickness absence and sick-leave duration as risk indicators for suicide attempt and suicide.

    METHODS: This is a population-based prospective cohort study. All non-retired adults (n=4 923 404) who lived in Sweden as on 31 December 2004 were followed-up for 6 years regarding suicide attempt and suicide (2005-2010). HRs and 95% CIs for suicidal behaviour were calculated, using people with no sick-leave spells in 2005 as reference.

    RESULTS: In analyses adjusted for sociodemographic factors and previous mental healthcare, suicide attempt and current antidepressants prescription, sickness absence predicted suicide attempt (HR 2.37; 95% CI 2.25 to 2.50 for women; HR 2.69; 95% CI 2.53 to 2.86 for men) and suicide (HR 1.91; 95% CI 1.60 to 2.29 for women; HR 1.92; 95% CI 1.71 to 2.14 for men), particularly mental sickness absence (range of HR: 2.74-3.64). The risks were also increased for somatic sickness absence, for example, musculoskeletal and digestive diseases and injury/poisoning (range of HR: 1.57-3.77). Moreover, the risks increased with sick-leave duration.

    CONCLUSIONS: Sickness absence was a clear risk indicator for suicidal behaviour, irrespective of sick-leave diagnoses, among women and men. Awareness of such risks is recommended when monitoring sickness certification. Further studies are warranted in order to gain more detailed knowledge on these associations.

  • 24.
    Åkerstedt, Torbjörn
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Perski, Aleksander
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Sleep, Stress and Heart Disease2012In: Stress and Cardiovascular Disease / [ed] Paul Hjemdahl, Andrew Steptoe, Annika Rosengren, London: Springer London, 2012, p. 257-272Chapter in book (Refereed)
    Abstract [en]

    It is estimated that sleep problems affect around 20% of the adult population in the Western countries.1,2 It has been shown that the short-term consequences of sleep problems lead to adverse physiological changes,3 as well as to long-term health consequences. In experimental and epidemiological studies, both short and long sleep hours have been related to hypertension,4 type-2 diabetes,5,6 increased body mass index (BMI),7 alterations in blood lipids,8 and inflammatory markers9 – all factors known to increase the risk of cardiovascular disease.

  • 25.
    Åkerstedt, Torbjörn
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Perski, Aleksander
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Sleep, Occupational Stress, and Burnout2016In: Principles and Practise of Sleep Medicine / [ed] Meir H. Kryger, Thomas Roth, William C. Dement, Philadelphia: Elsevier, 2016, 6, p. 736-741Chapter in book (Refereed)
1 - 25 of 25
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