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Environmental intolerance: psychological risk and health factors
Umeå University, Faculty of Social Sciences, Department of Psychology.ORCID iD: 0000-0001-9939-5601
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Environmental intolerance (EI) is an embracing term for a number of conditions characterized by a wide range of non-specific symptoms attributed to certain environmental exposures (e.g. pungent/odorous chemicals, residing in a certain building, electromagnetic fields and everyday sounds). EI often leads to lifestyle alterations (e.g. not taking part of activities formerly engaged in) and functional impairment (e.g. not being able to work, social deprivation). The etiology of the conditions is largely unknown, though there is growing empirical evidence for associations between mental ill-health and EI. However, mainly cross-sectional studies have been conducted which cannot demonstrate temporality. Further on, the prognosis for EI is not well-known.

This thesis includes four studies based on cross-sectional (Study 1) and longitudinal (Study 2-4) data from the Västerbotten Environmental Health Study (VEHS). The VEHS contains data from three data collections performed on the same set of respondents in 2010 (T1; n=3406), 2013 (T2; n=2336) and 2016 (T3; n=1837). In Study 1 the co-prevalence between EI attributed to chemicals, certain buildings, EMFs and sounds was investigated. The co-prevalence between all types of self-reported EI was greater than predictions based on coincidence, indicating that the different types of EI are associated, possibly sharing the same pathogenesis or that the afflicted individuals share some common predisposition to acquire the conditions. In Study 2 coping strategies and social support in EI were investigated and particularly whether certain combinations of different types of coping and social support may be important in recovering from EI. The participants who recovered from EI showed different combinations of coping strategies and social support than those who did not recover. In Study 3 the temporality between EI (attributed to chemicals, buildings and sounds) and psychological factors was investigated. The results showed that stress, anxiety, depression and burnout are risk factors for EI attributed to chemicals and sounds, but not for EI attributed to buildings. Changing perspective, EI attributed to buildings was a significant predictor of burnout, whereas EI attributed to sounds and chemicals were not. In Study 4 the prognosis of EI during a six-year period was studied. The probability of recovering from a state of specific EI was 44.3%, the probability of a specific EI to spread to other types of EI was 12.8%, and the probability of relapse was 3.9%. The participants who recovered showed lower levels of emotional and behavioral disruption than those who did not recover. The participants who showed spreading from one to several EIs perceived more stress than those who remained in a state of a specific EI, but had lower levels of burnout.

Based on the findings of the studies in the thesis it is suggested that psychotherapy focusing on reducing the emotional and behavioral reactions of exposure might be helpful. Even though the causation of EI is unknown, negative expectations about exposure might accumulate symptoms, setting a vicious circle into motion. The task of the psychologist might be to break this circle.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2017. , 88 p.
Keyword [en]
Environmental intolerance, stress, anxiety, depression, burnout, prognosis, recovery, spreading, coping, social support, co-prevalence, Västerbotten Environmental Health Study, idiopathic environmental intolerance, multiple chemical sensitivity, sick building syndrome, noise sensitivity, electromagnetic hypersensitivity
National Category
Psychology (excluding Applied Psychology)
Research subject
Psychology; Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-130289ISBN: 978-91-7601-658-9 (print)OAI: oai:DiVA.org:umu-130289DiVA: diva2:1065576
Public defence
2017-02-10, Hörsal F, Humanisthuset, Umeå Universitet, Umeå, 10:00 (English)
Opponent
Supervisors
Available from: 2017-01-20 Created: 2017-01-16 Last updated: 2017-01-17Bibliographically approved
List of papers
1. Overlap in prevalence between various types of environmental intolerance
Open this publication in new window or tab >>Overlap in prevalence between various types of environmental intolerance
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2014 (English)In: International journal of hygiene and environmental health (Print), ISSN 1438-4639, E-ISSN 1618-131X, Vol. 217, no 4-5, 427-434 p.Article in journal (Refereed) Published
Abstract [en]

Environmental intolerance (EI) is characterized by attribution of several, multisystem symptoms to specific environmental exposures, such as exposure to odorous/pungent chemicals, certain buildings, electromagnetic fields (EMFs) and everyday sounds. The symptoms are medically unexplained, non-specific and the symptoms overlap between different types of EI. To approach the issue of underlying mechanisms the matter of overlap in prevalence between intolerances can provide valuable information. The aim of the study was to examine if the overlap between intolerance to odorous/pungent chemicals, certain buildings, EMFs and sounds is larger than the expected overlap if no association would exist between them. The study was using cross-sectional data from the Västerbotten Environmental Health Study in Sweden; a large questionnaire-based survey. 8520 adults (18-79 years) were randomly selected after stratification for age and sex, of whom 3406 (40%) participated. Individuals with the four types of intolerance were identified either through self-report, or by having been physician-diagnosed with a specific EI. The overlaps between the four EIs were greater than predictions based on coincidence for both self-reported and diagnosed cases (except for the overlap between diagnosed intolerance to sounds and EMFs). The results raise the question whether different types of EI share similar underlying mechanisms, or at least that the sufferers of EI share some predisposition to acquire the conditions.

Place, publisher, year, edition, pages
Elsevier, 2014
Keyword
prevalence, environmental intolerance, multiple chemical sensitivity, noise sensitivity, sick building syndrome, overlap
National Category
Medical and Health Sciences Infectious Medicine Environmental Health and Occupational Health
Identifiers
urn:nbn:se:umu:diva-84580 (URN)10.1016/j.ijheh.2013.08.005 (DOI)000335113500001 ()24029726 (PubMedID)
Available from: 2014-01-09 Created: 2014-01-09 Last updated: 2017-01-16Bibliographically approved
2. Coping and social support in environmental intolerance
Open this publication in new window or tab >>Coping and social support in environmental intolerance
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Purpose: Environmental intolerance (EI) is a broad term encompassing several conditions characterized by unspecific symptom patterns attributed to certain environmental exposure, such as odorous/pungent chemicals, electromagnetic fields (EMFs) and sounds. Limited documentation of the role of coping strategies and social support in these EIs motivated the present study of (i) combinations of coping strategies and social support in high and low intolerance severity at baseline, and (ii) combinations of coping strategies and social support at baseline that are associated with recovery from EI at follow-up, three years later.

Methods: The study used cross-sectional and longitudinal data from the Västerbotten Environmental Health Study in Sweden, which is a large questionnaire-based survey. Individuals with EI attributed to chemicals, EMFs or sounds were identified through self-report (n=301 at baseline, n=213 at follow-up). The extent of use of four problem- and four emotion-focused strategies were assessed as well as perceived emotional, instrumental and informative support from seven sources.

Results: The low and high intolerance severity groups differed as a function of relatively high problem-focused coping and instrumental support compared to lower reported levels of informational support, emotion-focused coping and emotional support. The groups not recovering and recovering from EI differed as a function of relatively high instrumental support and problem-focused coping compared to lower reported levels of informational support, emotional support and emotion-focused coping.

Conclusions: The combination of coping strategies and perceived social support seem to be important in recovering from EI, for which emotion-focused coping, emotional and informational support seem to enhance recovery.

Keyword
Environmental intolerance, coping, social support, recovery
National Category
Psychology (excluding Applied Psychology)
Research subject
Psychology; Epidemiology
Identifiers
urn:nbn:se:umu:diva-130280 (URN)
Funder
Swedish Asthma and Allergy Association, 2012-030-K
Available from: 2017-01-16 Created: 2017-01-16 Last updated: 2017-01-17
3. Environmental intolerance and mental ill-health: which comes first?
Open this publication in new window or tab >>Environmental intolerance and mental ill-health: which comes first?
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Purpose: Environmental intolerance (EI) is a broad term encompassing several conditions characterized by unspecific symptom patterns attributed to certain environmental exposure. EI has previously been associated with mental ill-health, but prospective studies (enabling the direction of causality) within the field are sparse. This motivated the present study of testing whether (i) burnout, anxiety, depression and perceived stress are predictors of EI attributed to chemicals, certain buildings or sounds, and (ii) EI attributed to chemicals, certain buildings or sounds are predictors of burnout, anxiety or depression.

Methods: The study used longitudinal data from the Västerbotten Environmental Health Study in Sweden, which is a large questionnaire-based survey. Individuals with EI attributed to chemicals, certain buildings or sounds were identified through self-report. Logistic regression was used to test whether burnout (Shirom Melamed Burnout Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale), and perceived stress (Perceived Stress Scale-10) were predictors of EI, and, vice versa, whether EI attributed to chemicals, certain buildings or sounds were predictors of burnout, anxiety and depression. 

Results: Burnout, anxiety, depression and perceived stress predicted EI attributed to chemicals and sounds, but not EI attributed to certain buildings (after controlling for age, sex, other EIs and asthma). EI attributed to chemicals, certain buildings or sounds were not predictors of burnout, anxiety or depression, except for EI attributed to certain buildings which was a significant predictor of burnout.

Conclusion: The results provide important information about the cause-effect relations between EIs and mental ill-health, of value for both treatment and preventive healthcare for EI. 

Keyword
Environmental intolerance, depression, anxiety, perceived stress, burnout, risk factors
National Category
Psychology (excluding Applied Psychology)
Research subject
Psychology; Epidemiology
Identifiers
urn:nbn:se:umu:diva-130281 (URN)
Funder
Swedish Asthma and Allergy Association, 2012-030-K
Available from: 2017-01-16 Created: 2017-01-16 Last updated: 2017-01-17
4. Who recovers from environmental intolerance?
Open this publication in new window or tab >>Who recovers from environmental intolerance?
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Purpose: Environmental intolerance (EI) is a condition characterized by the attribution of symptoms to, and experience of negative hedonics of certain aspects in the environment (such as odorous/pungent chemicals, everyday sounds, and electromagnetic fields – EMFs). To date few studies have reported the prognosis of EI (i.e. recovery or generalization of a certain EI to an additional EI, thus general EI). Therefore, the purpose of the present study was to assess the chances of recovery from a specific EI as well as the chances of a specific EI to spread into general EI during a six-year period. The study also aimed to investigate whether levels of stress, burnout, anxiety, depression and emotional/behavioral disturbance of environmental sources could predict recovery from a specific EI.

Methods: Longitudinal data were used (three data-collection waves - T1: 2010, T2: 2013, T3: 2016) from the Västerbotten Environmental Health Study in Sweden. At T1, 539 participants reported a specific EI, constituting the sample. Two different probability calculations were used to estimate the chances of recovering from a specific EI or to develop general EI. The first calculation considered only those individuals who responded to the questionnaire at all three data-collection waves. The second calculation was based on the Chapman-Kolmogorov equation to calculate the 2-step transition probabilities, including all participants from T1. Multinomial logistic regression was used to test whether burnout (Shirom Melamed Burnout Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale), perceived stress (Perceived Stress Scale-10) and emotional and behavioral disturbance by environmental sources (Chemical Sensitivity Scale for Sensory Hyperreactivity, Electromagnetic Field Sensitivity Scale-11, and Noise Sensitivity Scale-11) were predictors of recovering from EI or spreading into general EI.

Results: The probability of recovering from EI was 44.3% according to the probability calculation based on the participants that remained in the study at T3. The probability of specific EI spreading into general EI was 12.8%. Based on the Chapman-Kolmogorov equation, 34.6% recovered and 10.0% reported general EI. The only significant predictor of recovery found in this study was CSS-SHR, in which one step increase of the scale reduced the odds of recovering by 0.94 times.

Conclusion: The results indicate that the prognosis for EI is fairly good and that low emotional and behavioral disruption by environmental exposure increases the odds of recovering.

Keyword
Environmental intolerance, prognosis, recovery, spreading
National Category
Psychology (excluding Applied Psychology)
Research subject
Psychology; Epidemiology
Identifiers
urn:nbn:se:umu:diva-130288 (URN)
Funder
Swedish Asthma and Allergy Association, 2012-030-KRiksbankens Jubileumsfond, M14-0375:1
Available from: 2017-01-16 Created: 2017-01-16 Last updated: 2017-01-17

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