Do somatic symptom distress and attribution predict symptoms associated with environmental factors?

OBJECTIVE: Not much is known on the development of symptoms associated with environmental factors (SAEF), also known as (idiopathic) environmental intolerances. Findings from qualitative studies suggest that appearance of symptoms might be the first step, followed by the acquisition of a specific attribution. The current study investigated cross-sectional and longitudinal (three years) associations between attribution and symptoms with respect to symptoms associated with chemical substances, certain indoor environments (buildings), sounds, and electromagnetic fields (EMFs). METHODS: We used data from the first two waves of the population-based Västerbotten Environmental Health Study (n = 2336). Participants completed the Patient Health Questionnaire Somatic Symptom Scale (PHQ-15), the Environmental Symptom-Attribution Scale, and answered single questions on the four aforementioned SAEFs. RESULTS: Using binary logistic regression analyses, all four SAEFs showed significant cross-sectional associations with somatic symptom distress and the respective attribution. In the longitudinal analysis, development of SAEF-Sound and SAEF-Chemicals were predicted by both somatic symptom distress and attribution. SAEF-EMFs was predicted only by attribution, whereas neither somatic symptom distress nor attribution forecasted SAEF-Buildings. CONCLUSION: Overall, these findings suggest that attribution (i.e., a specific expectation) plays a substantial role in the development and maintenance of many SAEFs.

Does a multi-component intervention including pictorial risk communication about subclinical atherosclerosis improve perceptions of cardiovascular disease risk without deteriorating efficacy beliefs?

BACKGROUND: Pictorial communication about subclinical atherosclerosis can improve cardiovascular disease (CVD) risk, but whether it leads to long-term shifts in self-rated CVD risk (risk perception) and beliefs about possibility to influence personal risk (efficacy beliefs) is unknown. PURPOSE: To study the impact of personalized color-coded and age-related risk communication about atherosclerosis and motivational conversation, compared to traditional risk factor-based communication, on risk perception and efficacy beliefs. Also, whether risk perception increases with message severity. METHOD: The effect of the pragmatic RCT Visualization of Asymptomatic Atherosclerotic Disease for Optimum Cardiovascular Prevention (VIPVIZA) was analyzed using a linear mixed effects model with risk perception and efficacy believes at 1-year and 3-year follow up as dependent variables. Participants' (n = 3532) CVD risk perception and efficacy beliefs were assessed with visual analog scales (0-10). Fixed effects were group (intervention vs control), time point (1 year or 3 years) and interaction between group and time point. Further, the models were adjusted for corresponding baseline measurement of the dependent variable and a baseline × time point interaction. Effect of pictorial color-coded risk in the intervention group was investigated using a corresponding mixed effects model, but with pictorial risk group (message severity) as exposure instead of intervention group. RESULTS: After one year, the intervention group rated their CVD risk as higher (m = 0.46, 95% CI 0.32-0.59), with an effect also after 3 years (m = 0.57, 95% CI 0.43-0.70). The effect was consistent in stratified analyses by sex and education. Overall, no effect on efficacy beliefs was observed. In the intervention group, differences in CVD risk perception were found between participants with different color-coded risk messages on atherosclerosis status. CONCLUSION: Personalized, color-coded and age-related risk communication about atherosclerosis had an effect on risk perception with an effect also after 3 years, whereas overall, no effect on efficacy beliefs was observed.

From risk communication about asymptomatic atherosclerosis to cognitive and emotional reactions and lifestyle modification.

BACKGROUND: Non-adherence in the general population to preventive guidelines on cardiovascular disease calls for an interdisciplinary approach acknowledging psychological factors of relevance for risk communication and lifestyle modification. Evidence is building up regarding the advantage of sharing arterial imaging evidence of subclinical atherosclerosis with asymptomatic individuals, but there is limited understanding of how this relates to mechanisms of importance for behavioural change. Longitudinal studies on associations between patients' reactions and lifestyle modification are missing. The population-based randomized controlled trial VIPVIZA investigates the impact of pictorial information about subclinical atherosclerosis, added to traditional risk factor-based communication. The intervention includes a personalized, colour-coded and age-related risk communication strategy and a motivational conversation, and has been shown to reduce cardiovascular disease risk. METHODS: In the present study we assessed cognitive and emotional reactions to the intervention, and how these reactions are associated to lifestyle modification. The participants' evaluation of the risk communication was assessed in the intervention group (n = 1749). Lifestyle modification was assessed with a lifestyle index based on physical activity, diet, smoking and alcohol consumption at baseline and after 3 years. Associations between cognitive and emotional response and lifestyle modification were tested with analyses of covariance in a subset of participants (n = 714-857). RESULTS: The intervention increased understanding of personal CVD risk, the possibility to influence the risk, and how to influence the risk. Severity of atherosclerosis was associated with emotional reactions, but emotions of strong negative valence were uncommon. Cognitive response and emotional arousal evoked by the intervention were positively associated with lifestyle modification, whereas negative emotions in isolation were not. High level of cognitive response in combination with high level of emotional arousal was found to be most beneficial for lifestyle modification. CONCLUSIONS: The results demonstrate the potential of communicating asymptomatic atherosclerosis with a pictorial, colour-coded and age-related strategy, also including a motivational conversation. Furthermore, the results show the importance of CVD risk communication evoking engagement, and that an interaction between cognitive and emotional reactions might be central for sustained lifestyle modification. Our results also indicate that, in an asymptomatic population, atherosclerosis screening may strengthen disease prevention and health promotion. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01849575. Registration date 08/05/2013.

Associations between emotional support and cardiovascular risk factors and subclinical atherosclerosis in middle-age.

OBJECTIVE: To test the hypothesis of low emotional support being associated with lifestyle and biomedical cardiovascular disease (CVD) risk factors, estimated risk of CVD morbidity and mortality, and subclinical atherosclerosis in middle-aged healthy adults. METHODS AND MEASURES: Cross-sectional data were obtained from participants aged 40-60 years who had one or more conventional CVD risk factor. They underwent assessment based on questionnaires, clinical examination, blood sampling, and carotid ultrasound of plaque formation and carotid intima-media wall thickness (cIMT). Based on the Interview Schedule for Social Interaction, the participants were categorised as either low in emotional support (n = 884) or as a referent (n = 2570). Logistic regression analyses were conducted to study the associations. RESULTS: Logistic regression analyses showed that low emotional support was significantly associated with smoking, alcohol consumption and physical inactivity (OR = 1.53 - 1.94), estimated risk of CVD morbidity and mortality (OR = 1.56 - 1.68), and plaque formation (OR = 1.39). No significant associations were found regarding biomedical CVD risk factors or cIMT. CONCLUSION: The findings suggest that low social support is associated with lifestyle CVD risk factors, estimated risk of CVD morbidity and mortality, and subclinical atherosclerosis in middle-aged healthy adults, encouraging causal evaluation with longitudinal data investigating an impact of emotional support on mechanisms underlying CVD.

Associations between symptoms, modern health worries, and somatosensory amplification in patients with building-related symptoms.

OBJECTIVE: The objective of the present study was to investigate the associations between somatosensory amplification, modern health worries (MHWs), and symptoms among patients with building-related symptoms (BRS). METHODS: Patients with self-reported and medically confirmed BRS (n = 83) were included in this cross-sectional study. The Somatosensory Amplification Scale (SSAS) was used to quantify the tendency to amplify somatic sensations and perceive them as unpleasant and dangerous. Concerns about harmful effects of modern technologies were assessed with the Modern Health Worries Scale (MHWS). Symptoms commonly found in different forms of environmental intolerance were assessed with the Environmental Hypersensitivity Symptom Inventory (EHSI). RESULTS: Patients with BRS were characterized by more frequent and more severe environmental hypersensitivity symptoms compared to a reference population. Females and those with co-morbid self-reported chemical intolerance reported even more symptoms. MHWS and SSAS scores showed weak to moderate associations with symptoms, even after adjusting for socio-economic variables. However, neither the mean MHWS score or the SSAS score of our sample differed from normative scores. CONCLUSION: Patients with BRS are not characterized by elevated levels of MHWs and somatosensory amplification, thus other, psychosocial and/or environmental, factors may have contributed to the development of the condition. However, the associations between severity of symptoms and MHWs and somatosensory amplification suggest that psychosocial characteristics may substantially influence symptom experience in this group.

Modern health worries and annoyance from environmental factors are largely unrelated to smoking, alcohol consumption, and physical activity.

OBJECTIVE: Modern health worries, as well as environmental annoyance from chemical agents, noise, and electromagnetic exposure are associated with symptom reporting and marked affective-behavioural changes. As promotion and protection of health is a primary characteristic of these conditions, it can be expected that they will be related to less risk behaviour (smoking and alcohol consumption) and more health behaviour (physical activity), both cross-sectionally and longitudinally. METHODS: Hypotheses were tested in a sample of 2336 individuals participating in T1 and T2 data collection (3 years apart) of the Västerbotten Environmental Health Study, Sweden. Health-related behaviours were assessed using single self-report questions. Smoking was measured on a binary (yes-or-no) scale; frequency of alcohol consumption and physical activity was measured on a 5-point and a 4-point scale, respectively. RESULTS: Modern health worries showed no cross-sectional association with the three behaviours, whereas annoyance was typically inversely, very weakly, related to smoking and alcohol consumption. Physical activity was significantly positively associated only with chemical annoyance. None of the variables significantly predicted change of behaviours at T2 after controlling for the respective T1 value and demographic variables. CONCLUSIONS: Individuals with high levels of modern health worries and annoyance from various environmental agents are not clearly characterized by a healthier lifestyle. Perhaps they focus on the alleviation of their existing symptoms; alternatively, somatic symptom distress decreases their cognitive-affective resources necessary for a long-term life style change.

Impact of comorbidity on symptomatology in various types of environmental intolerance in a general Swedish and Finnish adult population.

Comorbidity with various health conditions is common in environmental intolerances (EIs), which restricts understanding for what symptoms that are associated with the intolerance per se. The present objectives were to study (i) prevalence of a broad range of specific symptoms in chemical, building-related, electromagnetic field- (EMF) related, and sound EI, irrespective of comorbidity, (ii) prevalence of symptoms in body systems in exclusive EIs, and (iii) increased risk of symptoms in body systems in exclusive EIs that cannot be referred to functional somatic syndromes, inflammatory diseases or mental disorders. Cross-sectional data (n = 4941) were used from two combined population-based surveys, the Västerbotten (Sweden) and Österbotten (Finland) Environmental Health Studies. Categorization of EI cases and controls were based on self-reports. Symptoms were assessed with the Environmental Hypersensitivity Symptom Inventory, and these were converted to 27 symptoms of the International Classification of Primary Care, 2nd edition, in eight chapters of body systems. The results showed, with few exceptions, that all assessed specific symptoms were significantly more prevalent in all four EIs than in referents. Although a large overlap between EIs, characteristic body system symptoms were eye and respiratory symptoms in chemical and building-related intolerance, skin symptoms in EMF-related intolerance, and general and unspecified, digestive, eye, cardiovascular, neurological, and psychological symptoms in sound intolerance. After controlling for various comorbidities, all studied body system symptoms were positively associated with chemical intolerance, fewer with sound intolerance, only one with building-related intolerance, and none with EMF-related EI. In conclusion, a broad range of symptoms are reported in all four EIs implying common mechanisms, but symptoms of certain body systems are more likely to be reported in a certain EI that cannot be explained by comorbidity.

Stress, mental ill-health and functional somatic syndromes in incident and chronic sleep disturbance in a general adult population.

Objective: Sleep disturbance may constitute health problems for the afflicted individual, but documentation of its chronicity is sparse. The objective was to investigate the extent to which incident and chronic sleep disturbance are associated with stress, mental ill-health and functional somatic syndromes. Design: This was a prospective, longitudinal study with 3-year interval between two assessments (T1 and T2), with a population-based sample forming groups with incident sleep disturbance (disturbance only at T2; n = 303), chronic sleep disturbance (disturbance at T1 and T2; n = 343) and without sleep disturbance (neither at T1 nor T2; n = 1421). Questionnaire data were used at T2 of physician-based diagnosis of anxiety disorder, depression, exhaustion syndrome, and functional somatic syndrome as well as of degree of stress, burnout, anxiety and depression. Results: Significant associations were found between chronic sleep disturbance and all four diagnoses (odds ratios = 1.74-2.19), whereas incident sleep disturbance was associated only with exhaustion syndrome and depression (odds ratios = 2.18-2.37). Degree of stress, burnout, anxiety and depression increased significantly from the referents to incident and chronic sleep disturbance, in that order (eta2 = 0.083-0.166), except for the two latter groups not differing in depression. Conclusion: The findings imply that healthcare professionals should be observant regarding various conditions of, apart from stress, mental ill-health and functional somatic syndromes in patients who present themselves with sleep disturbance, and in particular chronic disturbance.

Somatic symptoms in burnout in a general adult population.

OBJECTIVE: Burnout results in individual suffering and high societal costs, and is associated with somatic symptoms, anxiety and depression, calling for prevention by early identification. The objectives were to (i) determine prevalence of specific somatic symptoms in burnout, (ii) identify the symptoms, referred to as somatic symptoms of burnout (SS-B), that are particularly associated with burnout, (iii) determine their extent of association with burnout, and (iv) determine how well a certain number of SS-B differentiates participants with and without burnout in a general Swedish adult population. METHODS: Cross-sectional, population-based data were used from 687 participants high on burnout, and 2544 referents based on the Shirom-Melamed Burnout Questionnaire. The Patient Health Questionnaire 15-item Somatic Symptom Severity Scale was used to assess common somatization symptoms, and the Hospital Anxiety and Depression Scale to assess anxiety and depression. RESULTS: Feeling tired/having low energy, back pain, joint/limb pain, trouble sleeping, headaches, stomach pain, nausea/gas/indigestion, and constipation/loose bowels/diarrhea were most prevalent in burnout (57.2-95.0%). These symptoms, except for joint/limb pain, and dizziness, were also identified as the SS-B, with odds ratios of 2.34-12.74 and 1.95-9.11 when adjusted for background variables, and for anxiety and depression, respectively. Corresponding odds ratios for each additional number of SS-B were 1.69 and 1.52, respectively. The highest balanced accuracy (71.6%) for predicting burnout was found for ≥4 SS-B. CONCLUSION: Fatigue, pain and gastrointestinal symptoms are particularly common in burnout. Further studies may show whether clinicians should consider screening for burnout when patients present with SS-B without pathophysiological explanations.

Cognitive and emotional reactions to pictorial-based risk communication on subclinical atherosclerosis: a qualitative study within the VIPVIZA trial.

OBJECTIVES, SETTING AND SUBJECTS: Atherosclerosis screening with ultrasound is non-invasive and can be used as part of risk communication. The potential of personalised and pictorial-based risk communication is assessed in VIPVIZA, a population-based randomised controlled trial that aims at optimising cardiovascular disease (CVD) prevention by investigating the impact of visualisation of subclinical atherosclerosis. The present aim was to explore cognitive and emotional reactions evoked by the intervention as well as attitudes to any implemented life style changes in VIPVIZA participants in the intervention group with improved health status and furthermore to study possible interactions between these factors. Understanding mechanisms of action was central since non-adherence to preventive guidelines are often faced in clinical practice. DESIGN: In-depth interviews with 14 individuals were analysed with qualitative content analysis. RESULTS: Cognitive and emotional processes were highly interlinked and described by the main theme Cognitive and emotional reactions in strong interplay for orchestration of health oriented behavioural change. The informants' descriptions revealed two distinctly different psychological processes which constituted the two subthemes, Problem-focused coping and Encouragement-driven process. CONCLUSIONS: The results highlight that an interaction between emotional reactions and efficacy beliefs is important in facilitating behavioural change. Furthermore, the results underscore the importance of the risk message being perceived as clear, accurate, reliable and also emotionally engaging and thereby show why atherosclerosis screening and pictorial-based risk communication have the potential to contribute to effective CVD prevention strategies and shared decision making in primary care. Trial registration: ClinicalTrials.gov identifier: NCT01849575, registration 8 May 2013.Key pointsAtherosclerosis screening and pictorial-based risk communication have the potential to contribute to more effective CVD prevention strategies.Risk messages on atherosclerosis status were perceived as clear, accurate, reliable and emotionally engaging.An interplay between efficacy beliefs and emotional reactions facilitated behavioural change.Patients' understanding of CVD risk is important for shared decision-making and of relevance for non-adherence to preventive guidelines.

Risk factors for insomnia and burnout: A longitudinal population-based cohort study.

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 (n = 1702) and without burnout (n = 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.

Somatic symptoms in sleep disturbance.

Despite sleep disturbance and somatic symptoms being common health complaints, the relationship between these disturbances and single somatic symptoms is not well documented. The objectives of this study were to (i) identify somatic symptoms that are particularly associated with sleep disturbance, here referred to as somatic symptoms related to sleep disturbance (SS-SD), (ii) determine increased risk of sleep disturbance for each SS-SD and for a certain number of SS-SD, with and without controlling for anxiety and depression, and (iii) determine sensitivity and specificity for identifying sleep disturbance based on number of SS-SD in a general Swedish sample. Population-based, cross-sectional data based on validated questionnaire instruments were used from participants who constituted a sleep disturbance (n = 864) or a reference (n = 2340) group. Among 15 common somatic symptoms, stomach pain, back pain nausea/gas/indigestion, dizziness, and constipation/loose bowels/diarrhea were identified as SS-SD, with odds ratios of increased risk of sleep disturbance that ranged from 1.93 to 2.44 (1.36-1.79 and 1.54-1.91 when controlled for anxiety and depression, respectively). The risk of sleep disturbance increased by 1.44 times for each SS-SD (1.25 and 1.30 when controlled for anxiety and depression, respectively). A cutoff of two/three or more SS-SD had a sensitivity of 72.5/54.2% and a specificity of 50.0/69.7% for identifying sleep disturbances. When patients present with these somatic symptoms with or without a pathophysiological explanation, primary care clinicians may consider screening for sleep disturbance.

Subjective Impairments in Olfaction and Cognition Predict Dissociated Behavioral Outcomes.

BACKGROUND: Self-rated subjective cognitive decline (SCD) and subjective olfactory impairment (SOI) are associated with objective cognitive decline and dementia. However, their relationship and co-occurrence is unknown. We aimed to (a) describe the occurrence of SOI, SCD and their overlap in the general population; (b) compare SOI and SCD in terms of longitudinal associations with corresponding objective olfactory and cognitive measures; and (c) describe how SOI and SCD may lead to distinct sensory and cognitive outcomes. METHODS: Cognitively unimpaired individuals from the third wave of the Swedish population-based Betula study (n = 784, aged 35-90 years; 51% females) were split into self-rated SOI, SCD, overlapping SCD + SOI, and controls. Between-subject and within-subject repeated-measures MANCOVA were used to compare the groups regarding odor identification, cognition, age, sex, and education. Spearman correlation was used to assess the different patterns of association between olfaction and cognition across groups. RESULTS: SOI was present in 21.1%, whereas SCD was present in 9.9% of participants. According to a chi-square analysis, the SCD + SOI overlap (2.7%) is on a level that could be expected if the phenomena were independent. Odor identification in SOI showed decline at the 10-year follow-up (n = 284) and was positively associated with cognition. The SOI and SCD groups showed distinct cognitive-olfactory profiles at follow-up. CONCLUSIONS: SOI occur independently of SCD in the population, and these risk factors are associated with different cognitive and olfactory outcomes. The biological causes underlying SOI and SCD, as well as the risk for future cognitive impairment, need further investigation.

Construct validation and normative data for different versions of the Shirom-Melamed burnout questionnaire/measure in a Swedish population sample.

The overall aim of the present study was to examine the construct validity of different versions of the Shirom-Melamed Burnout Questionnaire/Measure (SMBQ/M) suggested in previous work, as well as to provide normative data for a large population-based sample in Sweden with a broad range in age. Cross-sectional data from the Västerbotten Environmental Health Study in Sweden were used. The 3406 participants (56% women) in this study, aged 18-79 years, constituted a random sample stratified for age and sex. Participants responded to a questionnaire including the 4-factor 22-item version of the SMBM as well as background questions and a number of validated questionnaire instruments assessing for example, sleep disturbance, depression, anxiety, perceived stress, and somatic symptoms. The dimensionality of different versions of the SMBM were examined with confirmatory factor analysis. A modified 4-factor 19-item model of the SMBM provided good model-fit, and two 2-factor models (11-item and 6-item) provided excellent model fit. The relationships to relevant psychological constructs provided support for convergent validity for the suggested versions of the SMBM. Finally, normative data were obtained for a broad age group for the different versions. In conclusion, we suggest that for assessing the core of the burnout construct in terms of emotional and physical exhaustion and cognitive weariness, the SMBM-11 or SMBM-6 for repeated measures, are to be used. For a broader assessment of burnout incorporating both symptoms and information about the process of exhaustion via the subscales of listlessness and tension, we recommend the use of the modified 4-factor SMBM-19.

Six-year prognosis of anxiety and depression caseness and their comorbidity in a prospective population-based adult sample.

BACKGROUND: Anxiety and depression are amongst the most prevalent mental health problems. Their pattern of comorbidity may inform about their etiology and effective treatment, but such research is sparse. Here, we document long-term prognosis of affective caseness (high probability of being a clinical case) of anxiety and depression, their comorbidity, and a no-caseness condition at three time-points across six years, and identify the most common prognoses of these four conditions. METHODS: Longitudinal population-based data were collected from 1,837 participants in 2010, 2013 and 2016. Based on the Hospital Anxiety and Depression Scale they formed the four groups of anxiety, depression and comorbidity caseness, and no caseness at baseline. RESULTS: The three-year associations show that it was most common to recover when being an anxiety, depression or comorbidity caseness (36.8 - 59.4%), and when not being a caseness to remain so (89.2%). It was also rather common to remain in the same caseness condition after three years (18.7 - 39.1%). In comorbidity it was more likely to recover from depression (21.1%) than from anxiety (5.4%), and being no caseness it was more likely to develop anxiety (5.9%) than depression (1.7%). The most common six-year prognoses were recovering from the affective caseness conditions at 3-year follow-up (YFU), and remain recovered at 6-YFU, and as no caseness to remain so across the six years. The second most common prognoses in the affective conditions were to remain as caseness at both 3-YFU and 6-YFU, and in no caseness to remain so at 3-YFU, but develop anxiety at 6-YFU. CONCLUSIONS: The results suggest that only 37 - 60% of individuals in the general population with high probability of being a clinical case with anxiety, depression, and their comorbidity will recover within a three-year period, and that it is rather common to remain with these affective conditions after 6 years. These poor prognoses, for comorbidity in particular, highlight the need for intensified alertness of their prevalence and enabling treatment in the general population.

Olfactory distortions in the general population.

Parosmia, distorted smell sensations, is a common consequence of respiratory virus infections. The phenomenon is not well understood in terms of its impact and long-term outcomes. We examined self-reported experiences of parosmia in a population-based sample from the Betula study that was conducted in Umeå in northern Sweden (baseline data collected in 1998-2000). We used a baseline sample of 2168 individuals aged 35-90 years and with no cognitive impairment at baseline. We investigated the prevalence of parosmia experiences and, using regression analyses, its relationship to other olfactory and cognitive variables and quality of life. Benefitting from the longitudinal study design, we also assessed the persistence of parosmia over 5 and 10 years prospectively. Parosmia experiences were prevalent in 4.8% of the population and it often co-occurred with phantosmia ("olfactory hallucinations"), but was not associated with lower self-rated overall quality of life or poor performance on olfactory or cognitive tests. For some individuals, parosmia was retained 5 years (17.0%) or even 10 years later (10.3%). Thus, parosmia experiences are commonly reported in the population, and can be persistent for some individuals, but might be mostly benign in nature. Our work complements research on clinical-level parosmia, which is typically more severe, and recent parosmia reports during the COVID-19 pandemic, where long-term outcomes are still unknown.

Exposures, Symptoms and Risk Perception among Office Workers in Relation to Nanoparticles in the Work Environment.

Submicroscopic nanoparticles (NPs) in air have received much attention due to their possible effects on health and wellbeing. Adverse health impacts of air pollution may not only be associated with level of exposure, but also mediated by the perception of the pollution and by beliefs of the exposure being hazardous. The aim of this study was to test a model that describes interrelations between NP pollution, perceived air quality, health risk perception, stress, and sick building syndrome. In the NanoOffice study, the level of NPs was measured and a survey on health risk perception was conducted among 260 employees in twelve office buildings in northern Sweden. Path analyses were performed to test the validity of the model. The data refute the model proposing that the NP exposure level significantly influences stress, chronic diseases, or SBS symptoms. Instead, the perceived exposure influences the perceived risk of NP, and the effect of perceived exposure on SBS and chronic disease is mediated by stress. There was little concern about nanoparticles, despite relatively high levels in some facilities. Perceived pollution and health risk perception may explain a large part of the environmentally induced symptoms and diseases, particularly in relatively low levels of pollution. The research results raise important questions on the physiologically or psychologically mediated health effects of air pollution.