Background: Sick Building Syndrome (SBS) is still in 2015 a controversial condition. The set of non-specific symptoms occurring in a particular building and not caused by specific illness such as allergy or infection are questioned. The variousSBS symptoms can be grouped as dermal, mucosal and general and there is no universally accepted clinical definition of SBS. Symptoms normally improve or disappear when people are not exposed in a particular building. SBS is a multifactorial disease and described as a syndrome caused or aggravated by many factors related to indoor environment such as dampness and mould, insufficiency of fresh air, but also psychosocial and individual factors like female gender and personality.
Objectives: The hypothesis is that personal factors such as previous health, actions taken, time, treatment, personality and coping resources are factors important in influencing the prognosis for SBS patients. The main purpose of this thesis is to explore more about how the symptoms affect work-capability and if SBS patients recover from their symptoms. Another important aim is to explore the experience of the emergence of symptoms and encounters in a group of people with SBS. To find out more about personality and coping resources and their importance for the progress of SBS symptoms comparisons were made with a selection from the general population, a group of patients having hand eczema and a group of patients with perceived sensitivity to electricity.
Methods: A follow-up questionnaire focusing on current medical and social status, care, treatment, other measures taken, coping and personality traits was sent to 239 patients with non-specific building-related symptoms, assessed during the period between 1986-1998 at the University Hospital in Umeå, Sweden, response rate 79,1%. Prognosis and risk factors for prognosis were calculated for the SBS patients. Measurement of personality traits like self-image was done using Structural analysis of Social Behaviour, SASB, and coping ability was measured with Coping Resources Inventory, CRI. Similar follow-up questionnaires for patient groups with hand eczema and perceived electrical sensitivity were used and response rates were 68% respectively 73%. Risk factors for prognosis with focus on self-image and coping were calculated for the SBS patients and the group of patients having hand eczema. Comparisons were made between self-image and coping among SBS patients, patients with electrical hypersensitivity, patients with hand eczema and a selection from the general population. To explore the experience of SBS symptoms and encounters a semi-structured interview was performed with 10 informants with symptoms of SBS. Five of them were previously diagnosed and had participated in the earlier follow-up study. The remaining five had had SBS symptoms for a shorter period. The interviews were analysed using qualitative content analysis.
Results: The degree and severity of SBS symptoms decreased over time, although nearly half of the SBS patients claimed that symptoms were more or less unchanged after 7 years or more. The risk of having no work capabilities was significantly increased at follow-up if the time from debut to first visit at the hospital clinic was more than one year and this risk was also significantly higher if the patient at the first visit had 5 or more symptoms. Common daily activities, like going by bus, also aggravated the SBS symptoms according to answers in the questionnaires.
The informants’ experiences of the emerging SBS symptoms are that when they first appear they are often similar to those of flu like runny nose and eyes, hoarseness, cough, and headache. Many of the informants act to change the way they manage the situation as a result of increased symptoms. During this whole process the informants/patients perceived a lack of confirmation and support from e.g. employers, primary health care and occupational health care centres.
Regarding self-image, all three patient groups scored higher on spontaneous and positive self-image than a comparison group. They were all less controlled. The patients with hand-eczema together with the patients with perceived electrical sensitivity also had a high score on negative self-image. CRI- domains did not differ between patients and comparison group except on CRI cognitive, were the hand eczema patients had a lower score than the comparison group contrary to SBS patients who had a higher score than the comparison group. The patients with perceived electrical sensitivity had a higher score on CRI spiritual. Self-image or coping ability was not associated with SBS symptoms or persistent hand eczema symptoms at follow-up and their personality did not affect their work capability. Previous atopic dermatitis was the only consistent predictor of hand eczema at follow-up.
Conclusion: Within this group of SBS patients there are long lasting symptoms aggravated by environmental factors. The results support that early and comprehensive measures for rehabilitation are essential for these patients. In the beginning the symptoms of SBS are diffuse and difficult to recognise for all involved. Patients with SBS symptoms experience a lack of confirmation and support. It is important that healthcare personnel confirm the patient and are aware of the possible connection between symptoms and the indoor environment. For employers and facility managers knowledge of their obligations in terms of working environment is important. Differences in personality traits were seen in a well-established condition and not only in patients with medically unexplained symptoms. This can imply that patients with general chronic symptoms can deviate from the general population with respect to self-image and coping ability. Certain personality traits may be potential risk factors that increase the probability of encountering and experiencing stressful work situations.