Complex symptomatology among young women who present with stress-related problems.

INTRODUCTION: In Scandinavia and globally, mental health and stress-related problems among adolescent girls and young women are public health concerns that need attention. The aim of this study was to investigate mental health and somatic symptoms with a special focus on internalised problems, self-image and body-mind aspects of body perception in a group of adolescent girls and young women presenting with stress-related problems at a youth-friendly Swedish health centre, and to compare them with normative and clinical reference groups. METHODS: The participants were 47 adolescent girls and young women, aged 17-25 years. The adult self-report (ASR), social analysis of social behaviour (SASB) and body perception questionnaire (BPQ) were used to measure multiple symptom areas. RESULTS: Compared to reference groups, adolescent girls and young women report complex symptomatology with high levels of internalised problems such as anxiousness, depression and somatic complaints. This manifested in attention problems, negative self-image and perceived bodily discomfort and distrust. CONCLUSION: Adolescent girls and young women emerging into adulthood present complex symptomatology of stress-related problems. This study gathered valuable information about their symptoms when they were seeking help. These young women showed higher symptom frequency than normative groups, and similar or higher symptom frequency than other clinical groups. Our findings of internalised and cognitive problems, including impaired self-image and body perceptions, point to the need for preventive strategies and tailored multidisciplinary interventions involving body-based methods to meet this complexity. Using tenets of stress theory, the complex symptomatology may be understood as logical responses to overwhelming stimuli and demands that exceed their ability to cope and disturb their 'equilibrium'. However, the complex gendered interplays between various external/internal stressors and a broad range of stress responses and health outcomes need further study in a long-term perspective.

'Girls need to strengthen each other as a group': experiences from a gender-sensitive stress management intervention by youth-friendly Swedish health services--a qualitative study.

BACKGROUND: Mental health problems among young people, and girls and young women in particular, are a well-known health problem. Such gendered mental health patterns are also seen in conjunction with stress-related problems, such as anxiety and depression and psychosomatic complaints. Thus, intervention models tailored to the health care situation experienced by young women within a gendered and sociocultural context are needed. This qualitative study aims to illuminate young women's experiences of participating in a body-based, gender-sensitive stress management group intervention by youth-friendly health services in northern Sweden. METHODS: A physiotherapeutic body-based, health-promoting, gender-sensitive stress management intervention was created by youth-friendly Swedish health services. The stress management courses (n = 7) consisted of eight sessions, each lasting about two hours, and were led by the physiotherapist at the youth centre. The content in the intervention had a gender-sensitive approach, combining reflective discussions; short general lectures on, for example, stress and pressures related to body ideals; and physiotherapeutic methods, including body awareness and relaxation. Follow-up interviews were carried out with 32 young women (17-25 years of age) after they had completed the intervention. The data were analysed with qualitative content analysis. RESULTS: The overall results of our interview analysis suggest that the stress management course we evaluated facilitated 'a space for gendered and embodied empowerment in a hectic life', implying that it both contributed to a sense of individual growth and allowed participants to unburden themselves of stress problems within a trustful and supportive context. Participants' narrated experiences of 'finding a social oasis to challenge gendered expectations', 'being bodily empowered', and 'altering gendered positions and stance to life' point to empowering processes of change that allowed them to cope with distress, despite sometimes continuously stressful life situations. This intervention also decreased stress-related symptoms such as anxiousness, restlessness, muscle tension, aches and pains, fatigue, and impaired sleep. CONCLUSIONS: The participants' experiences of the intervention as a safe and exploratory space for gendered collective understanding and embodied empowerment further indicates the need to develop gender-sensitive interventions to reduce individualisation of health problems and instead encourage spaces for collective support, action, and change.

Subjective health complaints in older adolescents are related to perceived stress, anxiety and gender - a cross-sectional school study in Northern Sweden.

BACKGROUND: Negative trends in adolescent mental and subjective health are a challenge to public health work in Sweden and worldwide. Self-reported mental and subjective health complaints such as pain, sleeping problems, anxiety, and various stress-related problems seem to have increased over time among older adolescents, especially girls. The aim of this study has therefore been to investigate perceived stress, mental and subjective health complaints among older adolescents in Northern Sweden. METHODS: Data were derived from a cross-sectional school-based survey with a sample consisting of 16-18 year olds (n = 1027), boys and girls, in the first two years of upper secondary school, from different vocational and academic programmes in three public upper secondary schools in a university town in northern Sweden. Prevalence of perceived stress, subjective health complaints, general self-rated health, anxiety, and depression were measured using a questionnaire, including the Hospital Anxiety and Depression Scale (HADS). RESULTS: A large proportion of both girls and boys reported health complaints and perceived stress. There was a clear gender difference: two to three times as many girls as boys reported subjective health complaints, such as headache, tiredness and sleeping difficulties and musculoskeletal pain, as well as sadness and anxiety. High pressure and demands from school were experienced by 63.6% of girls and 38.5% of boys. Perceived stress in the form of pressure and demands correlated strongly with reported health complaints (r = 0.71) and anxiety (r = 0.71). CONCLUSIONS: The results indicate that mental and subjective health complaints are prevalent during adolescence, especially in girls, and furthermore, that perceived stress and demands may be important explanatory factors. Future studies should pay attention to the balance between gender-related demands, perceived control and social support, particularly in the school environment, in order to prevent negative strain and stress-related ill-health. The gender gap in subjective adolescent health needs to be further explored.

Gender analysis of musculoskeletal disorders and emotional exhaustion: interactive effects from physical and psychosocial work exposures and engagement in domestic work.

The objective of this study was to assess the relationships between physical and psychosocial work exposures, engagement in domestic work and work-home imbalance in relation to symptoms of musculoskeletal disorders and emotional exhaustion in white- and blue-collar men and women. Three thousand employees from 21 companies were asked to answer a questionnaire on family structure, household and child care tasks, work exposure, work-home imbalance and symptoms of neck/shoulder disorders, low back disorders and emotional exhaustion. Women reported more musculoskeletal disorders and engagement in domestic work. Adverse at-work exposures were highest in blue-collar women. High engagement in domestic work was not separately associated with symptoms but paid work exposure factors were associated. High engagement in domestic work interacted with adverse work exposure and increased risk estimates for low back disorders and emotional exhaustion. Reported work-home imbalance was associated with neck/shoulder disorders in women and with emotional exhaustion in both women and men. PRACTITIONER SUMMARY: The current article adds to earlier research by showing that high engagement in domestic work is not separately associated with increased symptoms, but interacts with psychosocial work exposure variables to produce emotional exhaustion in both women and men and low back disorders in women.

Temperament and character personality dimensions in patients with nonspecific musculoskeletal disorders.

OBJECTIVE: The aim of this study was to investigate temperament and character dimensions in a group of patients with nonspecific musculoskeletal disorders and to show how personality is related to pain and psychologic distress in pain patients. METHOD: A total of 78 patients with musculoskeletal disorders were compared with a matched control group of 118 nonpatients. The Temperament and Character Inventory, the Symptom Check List, and the Multidimensional Pain Inventory were used. RESULTS: The pain patients differed significantly from the controls and exhibited a personality profile with high harm avoidance and low self-directness, which indicate that patients with nonspecific musculoskeletal pain disorders can be characterized as being cautious, insecure, and pessimistic. In addition, they can be described as having difficulties in accepting responsibility, lack of long-term goals, chronically low self-esteem, and struggle with identity. This is probably a salient characteristic of patients with chronic pain. The results also showed that personality dimensions had a stronger correlation to psychologic distress than to pain. The result indicated that harm avoidance probably is an important personality trait in anxiety states. CONCLUSIONS: The results underline the importance of using instruments assessing personality and psychologic symptoms in patients with nonspecific musculoskeletal disorders both as diagnostic tools and in treatment planning.

Gender-sensitive and youth-friendly physiotherapy: Steps toward a stress management intervention for girls and young women.

This article describes and evaluates initial steps of a gender-sensitive, youth-friendly group intervention model designed for teenage girls and young women who experience stress-related or psychosomatic problems. Fifty-four young women (16-25 years of age) participated in a gender-sensitive physiotherapy stress management course at a youth health center. Inclusion criteria were self-defined stress-related problems and a wish to participate in the group intervention. Measurements of aspects of body perception, self-image, multiple somatic problems, and mental health symptom areas were assessed both before and after intervention with the Body Perception Questionnaire ad modum Schiöler, social analysis of social behavior, and Adult Self-Report scale. Significant positive changes were found in aspects of body perception, self-image, and mental health and somatic symptoms. The changes were most significant in lower internalization of anxiety and depression symptoms. Symptoms such as headaches and sleeping problems decreased. Participants were more satisfied with their bodies and more able to listen to body signals. Among cognitive issues, significant change occurred in thought problems, but not in attention problems. The intervention model needs further evaluation in controlled trials, but is promising and should be developed further in other physiotherapy settings and subgroups of young people.

A comparison between three physiotherapy approaches with regard to health-related factors in patients with non-specific musculoskeletal disorders.

PURPOSE: The main aim of this study was to compare the effects of Body Awareness Therapy (BAT), the Feldenkrais (FK) method and conventional physiotherapy on changes of health-related quality of life (HRQL), self-efficacy and sense of coherence (SOC) in patients with non-specific musculoskeletal disorders. A second aim was to explore the relationships between SOC, HRQL and self-efficacy and to examine whether SOC could be a predictor of the treatment outcome. METHOD: A total of 78 patients, 64 women and 14 men, were recruited consecutively to the three treatment groups. The instrument used were the Swedish version of SF-36, the 20 items Arthritis Self-efficacy Scale and the 29-item questionnaire by Antonovsky. RESULTS: The results showed that there were significant improvements on all subscales of SF-36 except for one. By using effect-size values it was found that the BAT and FK groups reached larger effect-size than did the conventional therapy group. These two groups also improved in self-efficacy of pain and stayed stable while the third group deteriorated at the one-year follow-up. There were significant correlations between the mental dimensions of SF-36 and SOC indicating that the instruments may measure aspects of the same global construct. CONCLUSIONS: Although few significant differences between the three treatment groups the BAT and FK seemed to improve health-related quality of life and self-efficacy of pain to a somewhat higher degree than the conventional physiotherapy. SOC seemed to be a stable trait measure over time.

Feldenkrais® therapy as group treatment for chronic pain--a qualitative evaluation.

PURPOSE: This qualitative study describes and analyses the experiences and self-reported effects of those participating in a Feldenkrais group intervention. METHOD: Fourteen women with non-specific neck and shoulder pain participated in a group treatment design using the Feldenkrais Awareness Through Movement (ATM) method. Data were collected in two ways: diary notes directly after the sessions and thematic interviews 4-6 months after the intervention. Data were analysed with a Grounded Theory approach. RESULTS: One core category and two sub-categories emerged. The core category "Feldenkrais is wholesome, but difficult" represents the participants' major opinions about the group intervention. The sub-categories "More erect without effort", and "Extended space for myself", represent participants' descriptions of effects of the movement therapy. The women described changes in posture and balance, a feeling of release and increased self-confidence. Some ambivalence about the method was expressed, especially regarding the difficulty to continue the exercises at home. The women feelings of improved body awareness remained after 4-6 months. They were also more aware of their attitudes towards activities in daily life. This resulted in them not "sacrificing themselves" as they did before. In addition, the bodily and psychological changes and the concept of empowerment are discussed. CONCLUSIONS: Positive experiences from the Feldenkrais group treatment were reported, especially concerning movement ability and body awareness. The exercises were however regarded as difficult to perform as self-training on a daily basis.

Young women facing multiple and intersecting stressors of modernity, gender orders and youth.

This article aims to explore stressors experienced by Swedish adolescent girls and young women, specifically understood in relation to social context and gender theory. Interviews were conducted with 40 young Swedish women, aged 16-25 years, who had sought help at a youth health centre for stress problems. Using qualitative content analysis we identified three clusters of stressors: "the stressors of modernity", "the stressors of gendered orders", and "the stressors of youth". The results revealed that multiple and intersecting discourse-shaped stressors and demands connected to essential life spheres contribute not only to experiences of distress but also to feelings of constraint. Gendered individualism and healthism proved to be essential in understanding the young women's experienced stress. Failing social support from adults, gendered demands and responsibility taking were also illuminated. This calls for a broad contextualized and gender-sensitive approach to young women's stress and health problems.

"He messed me up": Swedish adolescent girls' experiences of gender-related partner violence and its consequences over time.

This article illuminates two Swedish adolescent girls' experiences of living in a violent relationship as teenagers and how this has affected their lives and health over time. Interviews were conducted in a youth health center. A combination of qualitative content analysis and narrative analysis describes violation, stress, trauma, coping, and agency during the period of adolescence and transition into adulthood. Despite Swedish progressive public policies on men's violence against women, teenage girls are exposed to male partners' violation, a severe gendered stressor. There is a need for the development of health policy and gender-responsive interventions geared specifically toward adolescent girls.

Quality of life and cost-effectiveness of a 3-year trial of lifestyle intervention in primary health care.

BACKGROUND: Lifestyle interventions reduce cardiovascular risk and risk of diabetes mellitus, but reports on long-term effects on quality of life (QOL) and health care utilization are rare. We investigated the impact of a primary health care-based lifestyle intervention program on QOL and cost-effectiveness over 3 years. METHODS: A total of 151 men and women, aged 18 to 65 years, at moderate to high risk for cardiovascular disease, were randomly assigned to either lifestyle intervention with standard care or standard care alone. Intervention consisted of supervised exercise sessions and diet counseling for 3 months, followed by regular group meetings over a 3-year period. Change in QOL was measured with EuroQol (5-dimensional EuroQol-5D [EQ-5D] and EuroQol-VAS [EQ-VAS]), the 36-Item Short-Form Health Survey (SF-36), and the 6-dimensional Short-Form 6D (SF-6D). The health economic evaluation was performed from a societal view and a treatment perspective. In a cost-utility analysis, the costs, gained quality-adjusted life-years (QALYs), and savings in health care were considered. Cost-effectiveness was also described using the net monetary benefit method. RESULTS: Significant differences between the groups over the 3-year period were shown in the EQ-VAS (P = .002), SF-6D (P = .01), and SF-36 (P = .04) physical component summary but not in the EQ-5D (P = .24) or SF-36 (P = .37) mental component summary. The net savings were $47 per participant. Costs per gained QALY, savings not counted, were $1668 to $4813. Probabilities of cost-effectiveness were 89% to 100% when the amount of $50,000 was used as stakeholder's threshold of willingness to pay for a gained QALY. CONCLUSION: Lifestyle intervention in primary care improves QOL and is highly cost-effective in relation to standard care. Trial Registration clinicaltrials.gov Identifier: NCT00486941.