The Efficacy of a Smartphone-Based App on Stress Reduction: Randomized Controlled Trial.

BACKGROUND: Stress management in the workplace is essential for a healthy mental and physical state. Due to technological advancements, individually tailored therapy and online cognitive behavioral therapy (CBT) are on the rise. OBJECTIVE: This study analyzed the efficacy of a smartphone app based on third-wave CBT tailored to an individual. METHODS: A randomized controlled trial was conducted with 126 participants who were divided into 2 groups. The intervention group used the smartphone app BetterLife for 10 weeks, while the control group was placed on a waiting list for the same duration. The Perceived Stress Scale-10 (PSS), Korean Utrecht Work Engagement Scale-9 (UWES), World Health Organization Quality of Life Assessment (WHOQOL), Beck Depression Inventory-II (BDI), and Beck Anxiety Inventory (BAI) were administered at baseline and after 10 weeks to both groups. RESULTS: Of the 126 participants, 11 dropped out during the trial. A 2-way repeated measure analysis of covariance was conducted, controlling for baseline BDI. There were greater improvements in PSS (F=24.33, P<.001, η2=0.17) and UWESK scores (F=8.32, P=.0046, η2=0.06) in the intervention group than in the control group. WHOQOL scores exhibited statistically significant improvement in the intervention group in the overall quality of life (F=8.19, P=.0049, η2=0.06), physical health (F=8.87, P=.003, η2=0.07), psychological health (F=13.32, P<.001, η2=0.10), social relationships (F=19.43, P<.001, η2=0.14), and environmental domains (F=10.14, P=.002, η2=0.08) but not overall health (F=1.68, P=.20). BDI (F=7.17, P=.008, η2=0.06) and BAI (F=6.00, P=.02, η2=0.05) showed a statistically significant improvement in the intervention group, but this significance did not survive the Bonferroni correction (P<.005). CONCLUSIONS: These results provide evidence that smartphone-based CBT is a viable option for reducing stress in the workplace. TRIAL REGISTRATION: Clinical Research Information Service KCT0003231; https://cris.nih.go.kr/cris/search/detailSearch.do/15137.

Effects of a multidisciplinary stress treatment programme on patient return to work rate and symptom reduction: results from a randomised, wait-list controlled trial.

BACKGROUND: To evaluate the efficacy of a multidisciplinary stress treatment programme. METHODS: General practitioners referred 198 employed patients on sick leave with symptoms of persistent work-related stress. Using a waitlisted randomised controlled trial design, the participants were randomly divided into the following three groups: the intervention group (IG, 69 participants); treatment-as-usual control group (TAUCG, 71 participants), which received 12 consultations with a psychologist, and the waitlisted control group (WLCG, 58 participants). The stress treatment intervention consisted of nine 1-hour sessions conducted over 3 months. The goals of the sessions were the following: (1) identifying relevant stressors; (2) changing the participant's coping strategies; (3) adjusting the participant's workload and tasks, and (4) improving workplace dialogue. Each participant also attended a mindfulness-based stress reduction (MBSR) course for 2 h a week over 8 weeks. RESULTS: The IG and TAUCG showed significantly greater symptom level (Symptom Check List 92) reductions compared to the WLCG. Regarding the return to work (RTW) rate, 67% of participants in the IG returned to full-time work after treatment, which was a significantly higher rate than in the TAUCG (36%) and WLCG (24%). Significantly more participants in the IG (97%) increased their working hours during treatment compared with the participants in the control groups, TAUCG (71%) and WLCG (64%). CONCLUSIONS: The stress treatment programme--a combination of work place-focused psychotherapy and MBSR--significantly reduced stress symptom levels and increased RTW rates compared with the WLCG and TAUCG.

Employees with mental disorders seeking support from the workers compensation system - experiences from Denmark.

BACKGROUND: In Europe it is commonly accepted that psychosocial hazards may influence the mental health of employees. However, mental disorders such as depression are generally not acknowledged as an occupational disease covered by the workers compensation system. Studies indicate that workers compensation claim processes may affect employee's health negatively due to a demanding case process. If filing a workers' compensation claim can harm the employees' health, it is highly relevant to pay attention to employees with mental health claims, as they are most likely vulnerable and face a very low chance of compensation. OBJECTIVE: This study investigates how employees with work-related mental disorders experience the process of seeking workers compensation from the Danish Workers' Compensation System. METHOD: Interview (N = 13) and questionnaire (N = 436) data from claimants were analysed. RESULTS: Analysis showed that even though many employees wished for the claim to influence the conditions at the workplace, there seemed to be a lack of preventive health and safety initiatives in the workplaces. Central stakeholders such as health and safety representatives were often not involved. Management involvement was often experienced negatively, and the Danish Working Environment Authority rarely conducted workplace inspections. Employees experienced inadequate information about the workers' compensation process and experienced a lack of coordination between stakeholders. CONCLUSION: A more supportive and coordinated approach in the Workers' Compensation System is recommendable. The processes in the system could be evaluated using the Social Insurance Literacy concept, to ensure sufficient support of the claimants and reduce potential harmful aspects of the process.

Effect of a multidisciplinary stress treatment programme on the return to work rate for persons with work-related stress. A non-randomized controlled study from a stress clinic.

BACKGROUND: In recent years an increasing number of patients have been referred to the medical sector with stress symptoms. Moreover, these conditions imply increased sickness absence. This indicates a need for treatment programmes in general medical practice. The aim of this study was to test the effect of a multidisciplinary stress treatment programme on the return to work (RTW) rate in persons with work-related stress and establish predictive factors for this outcome. METHODS: During a two-year period 63 out of 73 referrals to the Stress Clinic (a section of a Clinic of Occupational Medicine) completed a stress treatment programme consisted of the following:1) Identification of relevant stressors. 2. Changing the coping strategies of the participants. 3. Evaluating/changes in participant workload and tasks. 4. Relaxation techniques. 5. Physical exercise. 6. Psychiatric evaluation when indicated by depression test score.On average each patient attended six one-hour sessions over the course of four months.A group of 34 employees referred to the Clinic of Occupational Medicine by their general practitioners served as a control group. Each participant had a one-hour consultation at baseline and after four months. A specialist in occupational medicine carried out all sessions.Return To Work (RTW), defined as having a job and not being on sick leave at the census, was used as outcome measure four months after baseline, and after one and two years. RESULTS: The level of sick leave in the stress treatment group dropped from 52% to 16% during the first four months of follow-up and remained stable. In the control group, the reduction in sick leave was significantly smaller, ranging from 48% at baseline to 27% after four months and 24% after one year. No statistically significant difference between the two groups was observed after one and two years. Age below 50 years and being a manager increased the odds ratio for RTW after one and two years, while gender and depression had no predictive value. CONCLUSIONS: The stress treatment programme showed a significant effect on the return to work rate. The stress treatment programme seems feasible for general practitioners. TRIAL REGISTRATION: ISRCTN04354658.

Cancer morbidity among Danish male urban bus drivers: A historical cohort study.

OBJECTIVE: To investigate whether urban bus drivers are at increased risk for cancer. METHODS: Urban bus drivers in a cohort established in 1978 in the three largest cities of Denmark were followed-up in the Danish Cancer Registry until the end of 2003, and relative risks for cancers were estimated. RESULTS: Of 2,037 men included 70% reported in 1978 that they smoked. The standardized incidence ratio (SIR) for cancer in comparison with that of other male residents of the three cities was 1.09 [1.0-1.2]. The excess was due mainly to increased risks for cancers of the bladder (SIR, 1.6; 1.2-2.0) and lung (1.2; 1.0-1.4). In an analysis with internal comparisons and adjustment for smoking, we found no significant associations between duration of employment and increased risks for cancers at these two sites. CONCLUSIONS: In this long-term follow-up study we found little evidence of a causal association between employment as an urban bus driver in Denmark and subsequent cancer.

How do line managers experience and handle the return to work of employees on sick leave due to work-related stress? A one-year follow-up study.

PURPOSE: To examine how line managers experience and manage the return to work process of employees on sick leave due to work-related stress and to identify supportive and inhibiting factors. MATERIALS AND METHODS: Semi-structured interviews with 15 line managers who have had employees on sick leave due to work-related stress. The grounded theory approach was employed. RESULTS: Even though managers may accept the overall concept of work-related stress, they focus on personality and individual circumstances when an employee is sick-listed due to work-related stress. The lack of a common understanding of stress creates room for this focus. Line managers experience cross-pressure, discrepancies between strategic and human-relationship perspectives and a lack of organizational support in the return to work process. CONCLUSION: Organizations should aim to provide support for line managers. Research-based knowledge and guidelines on work-related stress and return to work process are essential, as is the involvement of coworkers. A commonly accepted definition of stress and a systematic risk assessment is also important. Cross-pressure on line managers should be minimized and room for adequate preventive actions should be provided as such an approach could support both the return to work process and the implementation of important interventions in the work environment. Implication for rehabilitation Organizations should aim to provide support for line managers handling the return to work process. Cross-pressure on line managers should be minimized and adequate preventive actions should be provided in relation to the return to work process. Research-based knowledge and guidelines on work-related stress and return to work are essential. A common and formal definition of stress should be emphasized in the workplace.

Neuromotor function in a cohort of Danish steel workers.

OBJECTIVE: With a longitudinal design to evaluate possible neuromotor impairment in a cohort of steel workers exposed to metal dust. MATERIAL: Ninety-two employees from a steel works were examined in 1989 and 1995. Sixty were re-examined in 2003. A non-matched control group was examined in 1996 (n=19) and in 2003 (n=14). Median blood manganese in 1989, 1995 and 2003 was 149, 171 and 155 nmol/l. Median blood lead in 1989 and 2003 was 0.76 and 0.22 micromol/l. Median air concentration of manganese at the steel works was estimated to be 0.11 mg/m3 in 1970s and was 0.03 mg/m3 in 1990s. Median air concentration of lead was estimated to be 0.13 mg/m3 in 1970s and was 0.01 mg/m3 in 1990s. METHOD: The Catsys 2000 system developed by Danish Product Development is computer-based device for measuring hand tremor, hand coordination and reaction time. RESULTS: Over all there were no statistically significant differences in neuromotor function between the participating steel workers, non-participating steel workers and controls in 1995/1996. Only reaction time for the right hand was slower for the participating steel workers. Compared with the control group the steel workers showed a decline in the ability to perform fast precise hand pronation/supination and finger tapping from 1995 to 2005. Correlation analysis showed no associations between test results for fast hand coordination and blood manganese and lead. Only seniority was associated with deterioration of beat regulation of fast pronation/supination of the hands. DISCUSSION: On a group basis the changes were subclinical, but they should none the less be taken seriously. CONCLUSION: Changes of neuromotor function measured as the ability to perform fast precise pronation/supination of the hands and fast precise finger tapping was shown in this cohort of steel workers. No causal relationships could be shown.

Cognitive function in a cohort of Danish steel workers.

OBJECTIVE: The aim of this study was to evaluate the level of possible cognitive impairment in a cohort of steel workers occupationally exposed to manganese and lead. MATERIAL: Ninety-two employees from an electro-steel works were examined in 1989 and 1995. Fifty-three were re-examined in 2003. Median age of the participants was 53 years, median duration of employment was 24 years, median blood manganese in 1989 and 1995 was 148 and 171 nmol/l, respectively, and median blood lead in 1989 was 0.79 micromol/l. Non-participants were comparable with participants, although they had a higher level of blood manganese in 1989 (186 nmol/l) and 1995 (186 nmol/l). Manganese level in the air was estimated below 1.9 mg/m3 in the 1970s. In the 1990s, manganese level in the air was below 0.28 mg/m3 in the majority of measurements. METHOD: Cognitive function was examined with the Cognitive Function Scanner, a computer-based neuropsychological test battery. From a published set of norms a subgroup (n=106) matched for gender, age and social status was extracted and used for comparison. RESULTS: Learning and memory, visuomotor and visuospatial function, concentration, attention, perception and vigilance were examined. Despite many statistically significant differences between the groups, it was not possible to interpret the results for the steel workers as being better or worse. In a visuomotor subtest, the pen-to-point test, the steel workers were much less accurate than the comparison group. This could be the result of an impaired ability to make fast accurate movements. There were no associations between pen-to-point test results and duration of employment or blood levels of manganese and lead. CONCLUSION: Intellectual impairment could not be shown with the Cognitive Function Scanner in this cohort of low to moderate manganese and lead exposed steel workers. A slight subclinical impairment of the visuomotor function was possibly found.

Changes in Allostatic Load during workplace reorganization.

OBJECTIVE: Allostatic Load (AL) represents the strain on the body produced by repeated physiologic or allostatic responses activated during stressful situations. Several cross-sectional studies have found empirical substantiation for the relationship between impaired psychosocial work environment and high AL. The aim of this longitudinal study is to investigate changes in AL during workplace reorganization that has been shown to cause impaired psychosocial work environment. Moreover, we aim to investigate the association between changes in AL and changes in psychosocial work environment (job strain, effort-reward imbalance) and psychological distress (stress symptoms and perceived stress). METHODS: A major reorganization of non-state public offices was effectuated in Denmark on 1 January 2007. In 2006 and 2008, we collected clinical and questionnaire data from 359 participants, 265 women and 94 men, employed in seven municipality or county administrations. Four municipalities and one county merged with others, while one municipality and one county remained unmerged. We calculated the AL score based on 13 physiological markers reflecting stress responses of the cardiovascular, metabolic, neuroendocrine and immune systems. We analysed changes in AL from 2006 to 2008. RESULTS: AL increased significantly during workplace reorganization in the whole study group but we observed only a tendency of significant increase in AL in the merger group compared with the control group. Moreover, we observed no association between the changes in AL and changes in psychosocial work environment and psychological distress. CONCLUSIONS: This result leaves the conclusion unclear but contributes to the limited research in this area with a longitudinal design and focus on low-risk levels and small changes in AL in healthy people as predictor of future disease.

Psychosocial factors at home and at work and levels of salivary cortisol.

BACKGROUND: Salivary cortisol as a physiological measure of stress has attracted great interest in recent years. METHOD: A 55 women and 28 men, all healthy volunteers, were included in a study on psychosocial factors at work and at home and salivary cortisol. General linear models, univariate and repeated measures, respectively, were used to evaluate the associations between psychosocial factors and cortisol excretion measured six times during a working day. Age, physical activity, tobacco use and the time of the first saliva sample were used as covariates. RESULTS: In the women, high degrees of time pressure, effort and effort reward imbalance were significantly associated with higher levels of cortisol. In the men, high degrees of effort, effort reward imbalance and overcommitment were significantly associated with higher levels of cortisol. CONCLUSION: Psychosocial factors are of significance to the level of salivary cortisol. The study emphasises the benefits of taking physiological measurements of stress in epidemiological studies.

Corrigendum to "Prognostic Factors of Returning to Work after Sick Leave due to Work-Related Common Mental Disorders: A One- and Three-Year Follow-Up Study".

[This corrects the article DOI: 10.1155/2015/596572.].

Progression in intima media thickness--the significance of hormonal biomarkers of chronic stress.

OBJECTIVE: The pathophysiological pathways from stress caused by psychosocial stress to IHD has not been dealt with very extensively. The objective of this study was to analyse the association between cortisol levels and progression in intima media thickness (IMT). METHODS AND RESULTS: In 1998 and 2002, 95 participants went through a clinical investigation including ultrasound of the artery carotis communis. Progression in IMT was analysed in relation to levels of salivary cortisol in 1998 and the average levels of salivary cortisol in 1998/2002. Further, the significance of conventional coronary risk factors, testosterone and dehydro-epiandrosterone sulphate (DHEAS) were evaluated. Among the men, only age and HDL-cholesterol (negative) were significantly correlated with progression in IMT. Among the women, awakening cortisol response was significantly correlated with progression in IMT. Testosterone and DHEAS were borderline significantly associated (negatively) with progression in IMT in both genders. CONCLUSION: Progression in atherosclerosis were determined by different risk factors in women and men. The awakening cortisol response was of great importance to IMT progression in women but not in men.

Prognostic Factors of Returning to Work after Sick Leave due to Work-Related Common Mental Disorders: A One- and Three-Year Follow-Up Study.

The aim of this paper was to assess the prognostic factors of return to work (RTW) after one and three years among people on sick leave due to occupational stress. Methods. The study population comprised 223 completers on sick leave, who participated in a stress treatment program. Self-reported psychosocial work environment, life events during the past year, severity of the condition, occupational position, employment sector, marital status, and medication were assessed at baseline. RTW was assessed with data from a national compensation database (DREAM). Results. Self-reported high demands, low decision authority, low reward, low support from leaders and colleagues, bullying, high global symptom index, length of sick leave at baseline, and stressful negative life events during the year before baseline were associated with no RTW after one year. Low work ability and full-time sick leave at inclusion were predictors after three years too. Being single was associated with no RTW after three years. The type of treatment, occupational position, gender, age, and degree of depression were not associated with RTW after one or three years. Conclusion. The impact of the psychosocial work environment as predictor for RTW disappeared over time and only the severity of the condition was a predictor for RTW in the long run.

The neurobehavioral impact of manganese: results and challenges obtained by a meta-analysis of individual participant data.

Results from a meta-analysis of aggregated data provoked a new analysis using individual data on the neuropsychological performance of occupationally exposed workers. Data from eight studies examining 579 exposed and 433 reference participants were included, 28 performance variables analyzed. The performance scores were adjusted for well-known individual-level covariates; the influence of possible, but unknown study-level covariates was attenuated by means of a z-normalization. Associations between performance and exposure were estimated by ANOVAs and ANCOVAs, the latter representing multi-level models. Four cognitive and motor performance variables each indicated significantly lower performances of exposed individuals when confounding was considered; slowed motor performances and deficits in attention and short-term memory were found. Performance on a single test was significantly related to the biomarker manganese in blood. The outcomes on susceptibility were weak. The slowing of responses was the most distinct feature of performances of exposed workers. It remains unclear, whether this result is related to the employed tests or provides important information about early stages of the neurotoxic impairment. More specific cognitive tests need to be employed to answer this question. The lack of dose-response relationships was related to features of the biomarker: it does not reflect the Mn in brain responsible for changes in performances.

[Stress and pressure or effect]. / Stress og belastning eller effekt.

Stress is in medical terms a condition characterized by physiological reactions and symptoms initiated by stressors. The physiological reactions increase the tone in the sympathetic nervous system, change metabolism in a catabolic direction and stimulate immunological reactions. The effect on health is dependent on the strength and duration of the stressors, how the situation is perceived, the resources of the individual, and to what extend coping succeeds. An increase in the prevalence of reported stress in the working population in Denmark has occurred from 1987 (8%) to 2005 (12%).

[Prevention and treatment of stress]. / Stress og profylakse samt behandling.

Prevention of stress should address the stressors and factors which modify the effect of these. At the community level legislation and agreements on the labour market are important tools. At the enterprise level policies to reduce stress and monitoring the psychosocial work environment has the first priority in prevention. Treatment of stress is often a long-term process involving diagnostic assessment, psycho-education and counselling. The Danish National Board of Health has published recommendations to both general practitioners and the public in this area.

Effort reward imbalance, and salivary cortisol in the morning.

BACKGROUND: Effort reward imbalance (ERI) is suggested to increase risk for stress and is hypothesized to increase cortisol levels, especially the awakening cortisol response, ACR. METHODS: In 2006 and 2008, 480 individuals collected saliva samples at awakening and 30 min post-awakening. Mixed effects models with subject as a random effect and appropriate covariates were used to evaluate associations between the Effort Reward Model, and salivary cortisol at awakening (S0), and ACR. RESULTS: ERI was negatively and significantly associated with S0 for women and positively associated with ACR. S0 and ACR increased significantly from 2006 to 2008. CONCLUSION: ERI was significantly associated with cortisol levels at awakening (inverse association) for women, and positively associated with ACR. The population experienced a significant increase in morning cortisol levels and ACR from 2006 to 2008, which may originate in a re-organization of the included work places.

Effort reward imbalance is associated with vagal withdrawal in Danish public sector employees.

OBJECTIVES: The current study analyzed the relationship between psychosocial work environment assessed by the Effort Reward Imbalance Model (ERI-model) and heart rate variability (HRV) measured at baseline and again, two years later, as this relationship is scarcely covered by the literature. METHODS: Measurements of HRV during seated rest were obtained from 231 public sector employees. The associations between the ERI-model, and HRV were examined using a series of mixed effects models. The dependent variables were the logarithmically transformed levels of HRV-measures. Gender and year of measurement were included as factors, whereas age, and time of measurement were included as covariates. Subject was included as a random effect. RESULTS: Effort and effort reward imbalance were positively associated with heart rate and the ratio between low frequency (LF) and high frequency power (HF) and negatively associated with total power (TP) and HF. Reward was positively associated with TP. CONCLUSION: Adverse psychosocial work environment according to the ERI-model was associated with HRV, especially in the form of vagal withdrawal and most pronounced in women.