Psychological and behavioral benefits of a stress/type A behavior reduction program for healthy middle-aged army officers

A randomized feasibility trial of the Midlife Black Women's Stress and Wellness intervention (B-SWELL); a community participatory intervention to increase adoption of Life's Simple 7 healthy lifestyle behaviors

BACKGROUND

Black women have a disproportionately higher incidence of cardiovascular disease-related mortality than other groups, yet they are less likely to receive culturally proficient education and competent preventive care.

PURPOSE

The purpose of this study was to determine feasibility of the Midlife Black Women's Stress and Wellness intervention (B-SWELL); a culturally adapted, 8-week group intervention leveraging stress reduction and goal setting to increase awareness and adoption of Life's Simple 7 (LS7) healthy lifestyle behaviors.

METHODS

A randomized feasibility trial was conducted. Participants (N = 48, mean age = 55 years) were randomized to the B-SWELL or a group wellness (WE) intervention that lacked stress reduction and goal setting instruction. We hypothesized that B-SWELL participants would achieve a lower perceived stress, greater self-efficacy, improved LS7 scores, fewer symptoms (depression and unhealthy days), and greater perceived general health compared to WE participants. Survey data were collected at three timepoints: baseline, 8 weeks, and 12 weeks.

RESULTS

Both B-SWELL and WE groups had low attrition and navigated the online platform well. Further, both groups experienced lower perceived stress, improved LS7 scores, reduced depressive symptoms, and greater perceived general health from baseline to 8 weeks. Based on data trends, participants in the B-SWELL had more improvement in perceived stress, self-efficacy, and mental and physical unhealthy days compared to WE participants.

CONCLUSION

The B-SWELL is a feasible intervention for midlife Black women. Positive data trends were found for both B-SWELL and WE groups. Based on observations from the feasibility study, a larger outcomes-based study is planned.

Kellner's Symptom Questionnaire, a Highly Sensitive Patient-Reported Outcome Measure: Systematic Review of Clinimetric Properties

INTRODUCTION

Patient-reported outcomes (PROs) are of increasing importance in clinical medicine. However, their evaluation by classic psychometric methods carries considerable limitations. The clinimetric approach provides a viable framework for their assessment.

OBJECTIVE

The aim of this paper was to provide a systematic review of clinimetric properties of the Symptom Questionnaire (SQ), a simple, self-rated instrument for the assessment of psychological symptoms (depression, anxiety, hostility, and somatization) and well-being (contentment, relaxation, friendliness, and physical well-being).

METHODS

The PRISMA guidelines were used. Electronic databases were searched from inception up to March 2019. Only original research articles, published in English, reporting data about the clinimetric properties of the SQ, were included.

RESULTS

A total of 284 studies was selected. The SQ has been used in populations of adults, adolescents, and older individuals. The scale significantly discriminated between subgroups of subjects in both clinical and nonclinical settings, and differentiated medical and psychiatric patients from healthy controls. In longitudinal studies and in controlled pharmacological and psychotherapy trials, it was highly sensitive to symptoms and well-being changes and discriminated between the effects of psychotropic drugs and placebo.

CONCLUSIONS

The SQ is a highly sensitive clinimetric index. It may yield clinical information that similar scales would fail to provide and has a unique position among the PROs that are available. Its use in clinical trials is strongly recommended.

Process Evaluation in Occupational Stress Management Programs: A Systematic Review

Objective.

To conduct a systematic review of workplace stress management intervention studies that have incorporated process evaluation.

Data Source.

Electronic databases such as PsycINFO and MEDline were searched.

Study Inclusion Criteria.

The inclusion criteria included interventions published in the English language that were focused on either individual- or organizational-level stress management interventions at the workplace, with an outcome evaluation.

Data Extraction.

Each article was coded on key process-relevant variables, including context, recruitment, reach, dose delivered, dose received, fidelity, implementation, and participant's attitudes toward the intervention. Studies that reported on at least one of these process variables were also coded on the following study characteristics: Participants, setting, evaluation design, intervention content, intervention format, and study outcomes.

Data Synthesis.

Statistical Package for the Social Science was used to analyze the data with descriptive statistics.

Results.

Of the 84 studies identified that met the study inclusion criteria, 52 (61.9%) reported findings on at least one of the key relevant process-relevant variables. Variables most frequently included were recruitment (30%), intervention dose received (22%), participants' attitudes toward intervention (19%), and program reach (13%). Fewer than half of the studies presented any findings linking process evaluation and outcome evaluation.

Conclusions.

The incomplete reporting of information relevant to process evaluation makes it difficult to identify reliable determinants of effective intervention implementation or outcomes.

A web-based training program using cognitive behavioral therapy to alleviate psychological distress among employees: randomized controlled pilot trial

Background

A number of psychoeducational programs based on cognitive behavioral therapy (CBT) to alleviate psychological distress have been developed for implementation in clinical settings. However, while these programs are considered critical components of stress management education in a workplace setting, they are required to be brief and simple to implement, which can hinder development.

Objective

The intent of the study was to examine the effects of a brief training program based on CBT in alleviating psychological distress among employees and facilitating self-evaluation of stress management skills, including improving the ability to recognize dysfunctional thinking patterns, transform dysfunctional thoughts to functional ones, cope with stress, and solve problems.

Methods

Of the 187 employees at an information technology company in Tokyo, Japan, 168 consented to participate in our non-blinded randomized controlled study. The training group received CBT group education by a qualified CBT expert and 1 month of follow-up Web-based CBT homework. The effects of this educational program on the psychological distress and stress management skills of employees were examined immediately after completion of training and then again after 6 months.

Results

Although the training group did exhibit lower mean scores on the Kessler-6 (K6) scale for psychological distress after 6 months, the difference from the control group was not significant. However, the ability of training group participants to recognize dysfunctional thinking was significantly improved both immediately after training completion and after 6 months. While the ability of participants to cope with stress was not significantly improved immediately after training, improvement was noted after 6 months in the training group. No notable improvements were observed in the ability of participants to transform thoughts from dysfunctional to functional or in problem-solving skills. A sub-analysis of participants who initially exhibited clinically significant psychological distress (K6 score ≥5) showed that the mean K6 score was significantly improved immediately after training completion for the training group compared to the control group (−2.50 vs −0.07; mean difference 2.43, 95% CI 0.55-4.31; d=0.61), with this effect remaining even after 6 months (−3.49 vs −0.50; mean difference 2.99, 95% CI 0.70-5.29; d=0.60).

Conclusions

Our results suggest that a brief stress management program that combines group CBT education with Web-based CBT homework moderately alleviates the distress of employees with clinically significant psychological distress. In addition, the program might help improve employees’ ability to evaluate their own stress management skills.

Personality disorders and perceived stress in major depressive disorder

The investigation of comorbidity between major depressive disorder (MDD) and personality disorders (PDs) has attracted considerable interest. Whereas some studies found that the presence of PDs has adverse effects on the course and treatment of MDD, others have failed to demonstrate this link. These inconsistent findings suggest that specific PD comorbidity might affect the course of MDD by modulating factors that increase the overall risk of depression, including an elevated tendency to perceive stress. To investigate whether the presence of a specific PD cluster was associated with elevated levels of stress appraisal, we administered the Perceived Stress Scale (PSS) before and after treatment to 227 MDD outpatients enrolled in an 8-week open-label treatment with fluoxetine. Following treatment, multiple linear regression analyses revealed that the presence of Cluster A, but not Cluster B or C, was associated with higher levels of perceived stress, even after adjusting for baseline depression severity and PSS scores, as well as various sociodemographic variables. The presence of Cluster A PD comorbidity was uniquely associated with elevated stress appraisal after antidepressant treatment, raising the possibility that stress exacerbation might be an important factor linked to poor treatment outcome in MDD subjects with Cluster A pathology.

The potential relationship between levels of perceived stress and subtypes of major depressive disorder (MDD)

OBJECTIVE

We wanted to explore whether major depressive disorder (MDD) subtypes (melancholic depression, atypical depression, double depression, and MDD with anger attacks) were related to levels of perceived stress, as measured by the Perceived Stress Scale (PSS).

METHOD

Our sample [n = 298; female = 163 (55%); mean age 40.1 +/- 10.5 years] consisted of out-patients with MDD. The Structured Clinical Interview for DSM-III-R, the 17-item Hamilton Rating Scale for Depression, the Anger Attack Questionnaire, and the PSS were administered prior to initiating treatment.

RESULTS

Depressed women had significantly higher levels of perceived stress (P = 0.02) than depressed men. Greater severity of depression at baseline was significantly related to higher levels of perceived stress (P < 0.0001). After adjusting for age, gender, and severity of depression at baseline, higher levels of perceived stress were significantly related to the presence of anger attacks (P < 0.0001; t = -4.103) as well as to atypical depression (P = 0.0013; t = 3.26).

CONCLUSION

Out-patients with MDD who are more irritable and/or present with atypical features have higher levels of perceived stress, indicating a potential reactive component to their depression.

The benefits of interventions for work-related stress

OBJECTIVES

This quantitative meta-analysis sought to determine the effectiveness of occupational stress-reducing interventions and the populations for which such interventions are most beneficial.

METHODS

Forty-eight experimental studies (n = 3736) were included in the analysis. Four intervention types were distinguished: cognitive-behavioral interventions, relaxation techniques, multimodal programs, and organization-focused interventions.

RESULTS

A small but significant overall effect was found. A moderate effect was found for cognitive-behavioral interventions and multimodal interventions, and a small effect was found for relaxation techniques. The effect size for organization-focused interventions was nonsignificant. Effects were most pronounced on the following outcome categories: complaints, psychologic resources and responses, and perceived quality of work life.

CONCLUSIONS

Stress management interventions are effective. Cognitive-behavioral interventions are more effective than the other intervention types.

Type A behavior intervention in primary health care reduces hostility and time pressure: a study in Sweden

This study evaluates the effects of an intervention on hostility and time pressure in primary health care patients. A total of 47 men and women were studied, of whom 22 participated in an intervention program and 25 were controls. The intervention group changed global Type A behavior, hostility and time pressure significantly more than the control group and this change was stable up to 2 years following the study. Men altered their behavior significantly more than women.

Psychosocial aspects of coronary artery disease related to military patients

OBJECTIVE

Coronary artery disease (CAD) is a major cause of nontraumatic morbidity and mortality in military personnel. Most studies of the psychosocial impact of CAD have dealt with civilian populations. The purpose of this paper is to highlight differences between military and civilian populations with CAD in 4 areas: depression and anxiety, social support, return to work, and stress.

METHOD

A computerized literature search from 1985 to 1995 using the search terms "stress," "cardiovascular," "cardiac," "depression," "military," "anxiety" and "psychosocial" was undertaken. Controlled and prospective studies of civilian patients were selected along with relevant studies involving military populations.

RESULTS

Unique characteristics of the military may be important factors in affecting the psychosocial outcome of military patients with CAD. These characteristics include a high level of denial of illness, strong social supports, a powerful military work ethic, and stressful situations unique to the military.

CONCLUSIONS

Most studies of the psychosocial impact of CAD are based on civilian populations. A review of available studies suggests that little is known about how military patients adapt to CAD, particularly with regard to symptoms of depression and anxiety, social impairment, and rates of return to work. Studies in this area are needed regarding the psychosocial aspects of CAD in military populations.

Hostility changes following antidepressant treatment: relationship to stress and negative thinking

It is unclear whether changes in hostility following treatment are primarily related to improvement in depressive symptoms or are also closely associated with reductions in negative thinking or perceived stress. We evaluated 94 outpatients with major depression before and after eight weeks of fluoxetine treatment by administering the Symptom Questionnaire (SQ) Hostility Scale, the Hamilton Rating Scale for Depression (HAM-D), the Cognitions Questionnaire (CQ) and the Perceived Stress Scale (PSS). We observed significant elevations in scores on these questionnaires in depressed patients as compared to normal controls. Following treatment with fluoxetine, there was a statistically significant reduction in scores on all four questionnaires. We observed that changes in SQ Hostility were significantly positively related to changes in both depression severity and perceived stress, with these relationships remaining significant after adjusting for gender and baseline SQ Hostility. The relationship between SQ Hostility changes and reductions in negative thinking became significant only after adjusting for gender and baseline SQ hostility. Our results suggest that the marked decrease in hostility following antidepressant treatment is related to a reduction in depressive symptoms, stress levels and negative thinking.

Physical fitness and perceived stress. Relationships with coronary artery disease risk factors

This study evaluated the relationship between two biochemical risk factors for coronary artery disease, serum lipids and dehydroepiandrosterone-sulfate (DHEA-S), and both fitness and perceived stress among a cohort of senior male Army officers (N = 331). The participants underwent a number of assessments gauging their fitness [exercise tolerance as measured by maximum ventilatory oxygen uptake (MVO2)], psychological well-being, and biochemical cardiovascular risk factors. Perceived stress was significantly and inversely related to DHEA-S levels, even after adjusting for age, though no relationship was found between perceived stress and serum lipids. Significant correlations were found between MVO2 and high-density lipoprotein cholesterol and inversely between MVO2 and triglycerides. Overall, the study's findings are generally consistent with the view that psychological stress and physical activity have opposite effects on parameters that affect cardiovascular status.

Physiologic benefits of a stress reduction program for healthy middle-aged Army officers

Stress reduction programs (SRPs) can reduce morbidity and mortality in patients with coronary artery disease (CAD). This study evaluated the effect of an SRP on metabolic and hormonal risk factors for CAD. Twenty army officers participating in an SRP, Group I, and a comparison group of seventeen SRP nonparticipants, Group C, volunteered to undergo measurement of dehydroepiandrosterone-sulfate (DHEA-S), cortisol, DHEA-S/cortisol ratio, testosterone, apolipoprotein-A1, apolipoprotein-B, triglycerides, cholesterol, fibrinogen, and leukocyte count both before and after the SRP period. No differences in the changes in biochemical risk factors for CAD were found between participant and nonparticipant except for DHEA-S. While Group C had a marked reduction in DHEA-S levels, Group I had a small increase. Previous studies indicate DHEA-S is inversely associated with extent of CAD and age-adjusted DHEA-S levels below 3.78 mumol/l confer an increased risk for CAD mortality. SRP participation appears to effect DHEA-S levels, possibly partially accounting for the benefits observed in SRPs among CAD patients.

Psychological, behavioral and biochemical risk factors for coronary artery disease among American and Italian male corporate managers

Differences in psychological, behavioral and biochemical risk factors for coronary artery disease (CAD) among male corporate managers of 2 countries (United States and Italy), with very different age-specific rates of mortality for CAD were evaluated. In all, 129 American (mean age 43 +/- 7 years) and 80 Italian (mean age 45 +/- 7 years) managers volunteered to participate in this study. Each subject was administered several questionnaires assessing various psychological and behavioral risk factors for CAD, and all 129 Americans and 55 of 80 Italians had their blood drawn between 8:00 and 9:30 AM after overnight fasting for the measurement of plasma levels of dehydroepiandrosterone-sulfate (DHEA-S), total cholesterol, triglycerides, and apolipoproteins A-I and B. Italian managers reported significantly more cynicism and hostility, and less enjoyment in leisure activities than did American ones. Furthermore, 40 Italian (51%) and only 18 American (14%) managers were smokers (this difference being statistically significant). Although no significant differences were found in factors positively related with CAD (cholesterol, triglycerides and apolipoprotein B), there were clear differences in parameters inversely correlated with the incidence of CAD. Italian managers had significantly lower levels of plasma DHEA-S and apolipoprotein A-I than did American ones. In conclusion, this study found that Italian managers had a significantly more unhealthy psychological and behavioral profile than did American ones, and had lower levels of those biochemical parameters (apolipoprotein A-I and DHEA-S) thought to have a protective role against development of CAD.