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Stress, sleep disturbance, and related ill-health: from prevalence and risk-factors to indicated interventions
Umeå University, Faculty of Social Sciences, Department of Psychology.ORCID iD: 0000-0002-2408-3205
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

With focus on stress-related ill-health and insomnia/sleep disturbance, the overall aim of this thesis was to determine severity and prevalence, risk factors and effectiveness of low-intensity group sessions. This was accomplished by taking epidemiological and quasi-experimental approaches. 

With the aim of examining symptom severity and prevalence of insomnia, burnout, anxiety, depression, and somatization across different age groups and sexes, Study I used cross-sectional data (n=3406) from the baseline data collection of the Västerbotten Environmental Health Study (VEHS). In comparison to men, women in most age groups exhibited higher levels of symptom severity and prevalence of caseness in various mental health conditions. Insomnia (28.6%) and burnout (17.3%) were common in the population.

With focus on risk factors for insomnia and burnout, Study II used a longitudinal design and VEHS data (n=1702–1972) to compare a range of mental and somatic conditions in a general population. The results showed that all examined health conditions were risk factors for cases of insomnia and burnout. For example, insomnia can increase the risk of developing burnout (odds ratio: 2.67), and burnout increase the risk of developing insomnia (odds ratio: 2.73), underscoring the importance of early detection and prevention. 

The aim of Study III was to examine the effectiveness of four low-intensity group sessions for stress (n=274) and sleep disturbance (n=106) conducted by psychology students. A non-randomized controlled trial design was used in primary care with naturally occurring groups. A control group (n=221) was recruited via social media. Whereas effects were small at post-treatment, a substantial proportion of the patients showed a reliable improvement or recovery at 3-month follow-up. 

This thesis provides support for the assumption that severity and prevalence of insomnia, burnout, anxiety, depression, and somatization are common in the population. Burnout and insomnia are mutual risk factors and underscore the importance of indicated prevention in primary care. Low-intensity group interventions facilitated by non-experts can be effective and scalable for patients with stress and sleep disturbance.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2024. , p. 118
Keywords [en]
Stress-related ill-health, Prevalence, Risk factors, Burnout, Insomnia, Non-experts, Low intensity psychological interventions, Primary care, Scalability, Indicated prevention.
National Category
Psychology
Research subject
Clinical Psychology; Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-222832ISBN: 978-91-8070-264-5 (print)ISBN: 978-91-8070-265-2 (electronic)OAI: oai:DiVA.org:umu-222832DiVA, id: diva2:1847552
Public defence
2024-04-26, UB A.240, Lindellhallen 4, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2024-04-05 Created: 2024-03-28 Last updated: 2024-04-02Bibliographically approved
List of papers
1. Severity and prevalence of various types of mental ill-health in a general adult population: age and sex differences
Open this publication in new window or tab >>Severity and prevalence of various types of mental ill-health in a general adult population: age and sex differences
2020 (English)In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 20, no 1, article id 209Article in journal (Refereed) Published
Abstract [en]

Background: Taking a broad approach, the aim of this study was to better understand severity and prevalence of various types of mental ill-health across age and sex groups in the general adult population. A first objective was to determine symptom severity of anxiety, depression, insomnia, burnout and somatization in combinations of different age groups and sex. A second objective was to determine prevalence of caseness of these types of mental ill-health in both absolute and relative terms in the combinations of age groups and sex.

Methods: Cross-sectional data based on validated questionnaire instruments were used from the Västerbotten Environmental Health Study in Sweden. In total, 3406 participants, aged 18 to 79 years, constituted a random sample stratified for age and sex.

Results: Severity and prevalence of anxiety, insomnia and burnout were high in women, in particular young women, and lower in older age groups. The prevalence rates for insomnia, burnout and somatization were particularly high based on the used cut-off scores. Men aged 30–49 years had the highest prevalence of mental ill-health compared to other age groups among men. Men and women aged 60–69 years had generally the lowest symptom severity and caseness. The prevalence of depression was similar in men and women in all age groups, whereas sex-related differences in extent in general were largest in the youngest age group, and gradually decreased with age.

Conclusion: The results suggest that focus in primary healthcare regarding mental ill-health should to be directed more towards insomnia, burnout and somatization, in particular in young women.

Place, publisher, year, edition, pages
BioMed Central, 2020
Keywords
Burnout, Epidemiology, Insomnia, Negative affect, Somatization
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-171786 (URN)10.1186/s12888-020-02557-5 (DOI)000534342400001 ()32393209 (PubMedID)2-s2.0-85084590093 (Scopus ID)
Projects
HUSS
Available from: 2020-06-15 Created: 2020-06-15 Last updated: 2024-03-28Bibliographically approved
2. Risk factors for insomnia and burnout: a longitudinal population-based cohort study
Open this publication in new window or tab >>Risk factors for insomnia and burnout: a longitudinal population-based cohort study
2023 (English)In: Stress and Health, ISSN 1532-3005, E-ISSN 1532-2998, Vol. 39, no 4, p. 798-812Article in journal (Refereed) Published
Abstract [en]

Insomnia and burnout are highly prevalent in the general population, calling for understanding of its causes. Taking a broad approach, the aim of this study was to determine various mental and somatic risk factors for development of insomnia and burnout and stratifying for sex and age group. Questionnaire data were used from a Swedish population-based sample aged 18–79 years, from which cohorts without insomnia (= 1702) and without burnout (= 1972) at baseline were followed-up after 3 years. Self-reports of eight mental and somatic conditions at baseline were used as independent variables in logistic regression analyses to predict development of insomnia and burnout at 3-year follow-up. All eight studied conditions were significant risk factors for development of both insomnia (odds ratio, OR = 1.62–2.73) and burnout (OR = 2.20–3.21). Burnout and poor self-rated health had the highest ORs for insomnia, and poor self-rated health, anxiety and somatic symptoms had the highest ORs for burnout. The ORs were generally similar between men and women, whereas age groups tended to differ in some of the risk factors. The study highlights the importance of a broad assessment of both mental and somatic conditions in the prevention of insomnia and burnout.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
epidemiology, mental health, public health, somatic health
National Category
Public Health, Global Health, Social Medicine and Epidemiology Applied Psychology
Identifiers
urn:nbn:se:umu:diva-204764 (URN)10.1002/smi.3218 (DOI)000920645800001 ()36634111 (PubMedID)2-s2.0-85147301936 (Scopus ID)
Funder
AFA Insurance, 190082
Available from: 2023-02-21 Created: 2023-02-21 Last updated: 2024-03-28Bibliographically approved
3. Impact of group interventions on stress and sleep problems in primary care
Open this publication in new window or tab >>Impact of group interventions on stress and sleep problems in primary care
Show others...
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objectives: The majority of patients who seek help for stress and sleep problems do so in primary health care in Sweden. However, the resources for psychological treatment are limited. The aim of this study was to assess the effectiveness of a low-intensity student-led group interventions, applying cognitive behavioral therapy (CBT) with an indicated prevention approach in primary care for recovery and reducing symptoms of stress and sleep disturbance.

Methods: Using a quasi-experimental design, interventions were conducted for stress (n=274, mean age=38 years, 75% women) and sleep (n=106, mean age=44 years, 56% women) problems in consecutively recruited primary care patients. These were compared with a control group (n=221, mean age=45 years, 91% women) recruited via social media. The interventions were CBT-based psychoeducative group interventions that consisted of four 90-min sessions and led by psychology students. Assessment was completed at pre- and post-intervention and at 3-month follow-up. Main outcome measures were the 10-item Perceived Stress Scale and the Shirom-Melamed Burnout Questionnaire for the stress intervention, and the Karolinska Sleep Questionnaire for the sleep intervention. The Hospital Anxiety and Depression Scale and the 15-item Patient Health Questionnaire were used to assess anxiety, depression and somatization as secondary outcome measures for both interventions. Analysis of covariance (pre- vs post-intervention) and reliable change index (pre-intervention vs three-month follow-up) were applied.

Results: Statistically significant, but small effects of improved health in comparison to the control group were found on stress and burnout (η2=.021-.030) in the stress intervention, and on sleep (η2=.017) in the sleep intervention. The proportion of patients in the stress intervention with a reliable improvement at three-month follow-up was 28% for stress and 59% for burnout, and 0% and 33%, respectively, for the control group. Among those with a reliable improvement in burnout, 31% also met a recovery criterion (<4.0). In the sleep intervention, 25% of the patients showed a reliable improvement in sleep and 61% in burnout, and 6% and 33%, respectively, for the control group. The effects of the stress intervention were statistically significant, but small on anxiety and depression (η2=.021-.047), as were the effects of the sleep intervention on stress and burnout (η2=.017-.026). 

Conclusion: The results suggest that psychology students can effectively provide a low-intensity group-delivered CBT intervention for patients exhibiting symptoms of stress, burnout and sleep disturbance in routine general medical practice, offering promising opportunities for scalability expansion. Although the average treatment effects were small, a substantial proportion of the patients showed reliable improvement or recovery at 3-month follow-up. This suggests that the interventions decrease the prevalence of burnout and sleep disturbance or improve the well-being of individuals experiencing mental distress. 

Keywords
Stress, burnout, adjustment disorder, insomnia, stepped care, low-intensity psychological intervention
National Category
Other Health Sciences Psychology
Research subject
Clinical Psychology; Psychology
Identifiers
urn:nbn:se:umu:diva-222830 (URN)
Funder
AFA Insurance, 190082
Available from: 2024-03-28 Created: 2024-03-28 Last updated: 2024-04-02

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