The covariation between burnout and sick leave due to mental disorders is explained by a shared genetic liability: a prospective swedish twin study with a five-year follow-up

Effect of COVID-19 on Selected Characteristics of Life Satisfaction Reflected in a Fuzzy Model

The general goal of the research in this article is to devise an algorithm for assessing overall life satisfaction—a term often referred to as Quality of Life (QoL). It is aggregated to its own proposition, called personal life usual satisfaction (PLUS). An important assumption here is that the model is based on already known and commonly used solutions, such as medical (psychological and physiotherapeutic) questionnaires. Thanks to this, the developed solution allows us to obtain a synergy effect from the existing knowledge, without the need to design new, complicated procedures. Fuzzy multivariate characterization of life satisfaction presents a challenge for a complete analysis of the phenomenon. The complexity of description using multiple scales, including linguistic, requires additional computational solutions, as presented in this paper. The detailed aim of this study is twofold: (1) to develop a fuzzy model reflecting changes in life satisfaction test scores as influenced by the corona virus disease 2019 (COVID-19) pandemic, and (2) to develop guidelines for further research on more advanced models that are clinically useful. Two groups affected by professional burnout to different degrees were analyzed toward life satisfaction twice (pre- and during pandemy): a study group (physiotherapists, n=25) and a reference group (computer scientists, n=25). The Perceived Stress Score (PSS10), Maslach Burnout Inventory (MBI), Satisfaction with Life Scale (SWLS), and Nordic Musculoskeletal Questionnaire (NMQ) were used. The resultant model is based on a hierarchical fuzzy system. The novelty of the proposed approach lies in the combination of the use of data from validated clinimetric tests with the collection of data from characteristic time points and the way in which they are analyzed using fuzzy logic through transparent and scalable hierarchical models. To date, this approach is unique and has no equivalent in the literature. Thanks to the hierarchical structure, the evaluation process can be defined as a modular construction, which increases transparency and makes the whole procedure more flexible.

A Cognitive Behavioral Model Proposing That Clinical Burnout May Maintain Itself

Burnout is common in many countries and is associated with several other problems such as depression, anxiety, insomnia, and memory deficits, and prospectively it predicts long-term sick-leave, cardiovascular disease, and death. Clinical burnout or its residual symptoms often last several years and a common assumption is that recovery takes a long time by nature, despite full time sick-leave and the absence of work stress. The literature suggests models that hypothetically explain the development, but not maintenance, of the syndrome. Based on cognitive and behavioral principles, stress research, and stress theories, this paper describes a theoretical model explaining how clinical burnout can develop and be maintained. While the development of clinical burnout is mainly explained by prolonged stress reactions and disturbed recovery processes due to work related stressors, maintenance of the syndrome is particularly explained by prolonged stress reactions and disturbed recovery processes due to the new context of experiencing burnout and being on sick-leave. Worry about acquired memory deficits, passivity and excessive sleep, shame, fear of stress reactions, and the perception of not being safe are examples of responses that can contribute to the maintenance. The model has important implications for research and how to intervene in clinical burnout. For example, it can offer support to professional care providers and patients in terms of focusing on, identifying, and changing current contextual factors and behaviors that maintain the individual’s clinical burnout symptoms and by that facilitate burnout recovery. Regarding research, the model provides a highly important reason for researchers to study contextual factors and behaviors that contribute to the maintenance of clinical burnout, which has been neglected in research.

Epigenetic perspective on the role of brain-derived neurotrophic factor in burnout

Brain-derived neurotrophic factor (BDNF) plays a potential role in the neurobiology of burnout, but there are no studies investigating the underlying genetic and epigenetic mechanisms. Our aim is to further explore the role of BDNF in burnout, by focusing on the Val66Met polymorphism and methylation patterns of the BDNF gene and serum BDNF (sBDNF) protein expression. We conducted a cross-sectional study by recruiting 129 individuals (59 with burnout and 70 healthy controls). Participants underwent a clinical interview, psychological assessment and blood sample collection. Polymorphism and DNA methylation were measured on DNA from whole blood, using pyrosequencing and sBDNF levels were measured using ELISA. We found significantly increased methylation of promoter I and IV in the burnout group, which also correlated with burnout symptoms. In addition, DNA methylation of promoter I had a significant negative effect on sBDNF. For DNA methylation of exon IX, we did not find a significant difference between the groups, nor associations with sBDNF. The Val66Met polymorphism neither differed between groups, nor was it associated with sBDNF levels. Finally, we did not observe differences in sBDNF level between the groups. Interestingly, we observed a significant negative association between depressive symptoms and sBDNF levels. The current study is the first to show that BDNF DNA methylation changes might play an important role in downregulation of the BDNF protein levels in burnout. The presence of depressive symptoms might have an additional impact on these changes.

Sick leave due to back pain, common mental disorders and disability pension: Common genetic liability

BACKGROUND

Back pain and common mental disorders are often comorbid and known risk factors for future disability pension. However, the reason for the covariation is not known. The aim was to investigate the common genetic and environmental influences on the covariation between sick leave due to back pain, sick leave due to common mental disorders and disability pension.

METHODS

Register data from the Swedish Social Insurance Agency on sick leave due to back pain, common mental disorders and disability pension between 2005 and 2018, in a population-based sample of 56,686 working age twins was used to construct biometric twin models to calculate if the covariation between the traits were due to Additive (A) or Dominant (D) genetic factors, Common environmental factors (C) or unique Environmental factors (E), for women and men.

RESULTS

The phenotypic correlations ranged between 0.17 and 0.25. A common factor common pathway AE model fitted best for both women and men. The latent underlying common factor, that explained the covariation was mostly explained by genetic factors (87% for women and 90% for men). Each trait was also influenced by its own unique genetic and unique environment factors. A higher heritability was found for disability pension than for sick leave.

CONCLUSIONS

The covariation between sick leave due to back pain and common mental disorders, and disability pension were mostly explained by common genetic factors, while the unique variation in each trait was influenced by both genetic and environmental factors not shared within the twin pairs.

SIGNIFICANCE

A common genetic liability seems to be of importance in the comorbidity of sick leave due to back pain and common mental disorders and the transition to disability pension, both among women and men. However, the proportion in each trait that was explained by genetic factors was somewhat higher for men than for women in all traits. This may be of importance to consider in intervention or prevention efforts.

Suicide attempt following sickness absence and disability pension due to common mental disorders: a prospective Swedish twin study

PURPOSE

The aim of this study was to investigate if sickness absence and disability pension (SA/DP) in general and due to specific common mental disorders (CMDs) are associated with subsequent suicide attempt among women and men by taking familial factors (genetics and shared environment) into consideration.

METHODS

This register-based cohort study includes 4871 twin pairs 18-65 years of age discordant for SA/DP due to CMDs 2005-2010. Twins were followed up for suicide attempt from inpatient and specialised outpatient care until December 2012. Conditional Cox proportional hazards regression models, adjusting for familial factors, were used to calculate hazard ratios (HR) with 95% confidence intervals (CI).

RESULTS

SA/DP due to CMDs was associated with a higher risk of suicide attempt (HR 3.14, CI 2.51-3.93). The risk of suicide attempt was five times higher among men and three times higher among women, compared to the SA/DP unaffected co-twins. In the diagnosis-specific analysis, SA/DP due to anxiety disorders resulted in the highest HR (4.09, CI 2.37-7.06) for suicide attempt, followed by depressive disorders (HR 3.70, CI 2.66-5.14) and stress-related disorders (HR 1.96, CI 1.35-2.84). The stratified analysis on zygosity indicates that there seems to be a genetic influence on the associations between SA/DP due to CMDs and suicide attempt, particularly among women and among those with SA/DP due to depressive disorders.

CONCLUSIONS

SA/DP due to CMDs was a risk factor for suicide attempt among women and men. Genetic factors might explain part of the associations for women and for those with SA/DP due to depressive disorders.

Sick leave due to mental disorders, morbidity and mortality: a prospective study of discordant twin pairs

PURPOSE

To investigate if sick leave due to mental disorders increases the risk of morbidity measured by inpatient and specialized outpatient care, and mortality among women and men, independent of familial factors.

METHODS

An open cohort study of 4979 twin pairs discordant for sick leave due to mental disorders was conducted in 2005-2013. Twins were followed up in the cause of death and national patient registries until the end of study, emigration, death, and inpatient and specialized outpatient care. Conditional Cox proportional hazard regression, adjusting for the familial factors shared by the twins, was used to calculate hazard ratios (HR) with 95% confidence intervals (CI). In case of non-proportional hazards, time-varying covariates were used.

RESULTS

Sick leave due to mental disorders increased the risk for inpatient care among men (HR: 1.90, CI 1.66-2.17) and women (HR: 1.39, CI 1.27-1.51). For men, the risk of outpatient care was higher the first 2 years (HR: 2.08, CI 1.87-2.31), after which it was attenuated (HR: 1.32, CI 1.02-1.70). For women, the HR was 1.57 (CI 1.47-1.68) for the whole study time. There was an increased risk of death among men (HR: 2.91, CI 1.70-4.99), but not among women (HR: 0.84, CI 0.53-1.35).

CONCLUSIONS

Sick leave due to mental disorders was a risk factor for mortality for men only, and increased the risk of inpatient and specialized outpatient care among both women and men, but the risks were higher for men when stratifying for sex.

Work-Home Interference, Perceived Total Workload, and the Risk of Future Sickness Absence Due to Stress-Related Mental Diagnoses Among Women and Men: a Prospective Twin Study

Purpose

Work-home interference has been proposed as an important explanation for sickness absence (SA). Previous studies show mixed results, have not accounted for familial factors (genetics and shared everyday environment), or investigated diagnosis specific SA. The aim was to study whether work-home interference and perceived total workload predict SA due to stress-related mental diagnoses, or SA due to other mental diagnoses, among women and men, when adjusting for various confounders and familial factors.

Methods

This study included 11,916 twins, 19–47 years (49% women). Data on work-to-home and home-to-work conflicts, perceived total workload, and relevant confounders were derived from a 2005 survey, and national register data on SA spells until 2013 were obtained. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Discordant twin pair design was applied to adjust for familial factors.

Results

Each one unit increase in work-to-home and home-to-work conflicts, and perceived total workload was associated with higher odds for SA due to stress-related mental diagnoses and to SA due to other mental diagnoses among women, when adjusting for sociodemographic factors (ORs 1.15–1.31). Including health or familial factors, no associations remained. For men, each one unit increase in work-to-home conflicts was associated with higher odds for SA due to stress-related diagnoses (ORs 1.23–1.35), independently of confounders.

Conclusion

Work-to-home conflict was independently associated with future SA due to stress-related diagnoses among men only. Health- and work-related factors seem to be important confounders when researching work-home interference, perceived total workload, and SA. Not including such confounders involves risking drawing incorrect conclusions. Further studies are needed to confirm sex differences and whether genetic factors are important for the associations studied.

The Dresden Burnout Study: Protocol of a prospective cohort study for the bio-psychological investigation of burnout

OBJECTIVES

The Dresden Burnout Study (DBS) is a 12-year longitudinal cohort study that aims to provide a description of the burnout syndrome on the basis of time and symptom criteria with a special focus on the search for biomarkers. Biological and psychosocial approaches are applied to examine the long-term course and consequences of burnout within a population-based German-speaking sample aged 18 to 68 years.

METHODS

Demographics and psychosocial data are generated by online assessments, including demographics and questionnaires on burnout, burnout-related constructs, work-environment, and health-related factors. The lab-based biomarker assessment includes endocrine, physiological, immunological, and epigenetic markers obtained from blood and hair samples. In addition, heart rate variability is also measured repeatedly. Within the first 2 years, the DBS collected psychosocial data from over 7,600 participants with biological data obtained from more than 800 individuals. During the following 10 years, detailed assessments of biomarkers and psychosocial factors will be collected in annual study waves.

RESULTS

Results will be generated during the following decade.

CONCLUSION

The findings of the DBS are expected to pave the road for an in-depth biopsychosocial characterization of burnout and to give insight into the long-term course and potential mental and physical health consequences of the burnout syndrome.

Adverse outcomes of sick leave due to mental disorders: A prospective study of discordant twin pairs

AIMS

The aim of this study was to investigate whether sick leave due to different mental disorders increased the risk of reoccurring sick-leave, disability pension and unemployment, taking genetics and shared environment into account.

METHODS

This register-based cohort study contains 2202 discordant twin pairs 18-64 years old, where one twin had sick leave due to a mental disorder 2005-2006. The end of the sick-leave spell was the start of follow-up for both twins. The twins were followed up for reoccurring sick-leave, disability pension and unemployment (> 180 days in a year), until December 2012. Analyses were censored for disability pension, death, emigration and old-age pension. Cox proportional hazards models with time-varying covariates were used to calculate hazard ratios with 95% confidence intervals (CI).

RESULTS

Those with sick leave due to mental disorders had a 3.64 (CI: 3.24-4.08) times higher risk of reoccurring sick-leave within the first two years; after that, hazard ratios were attenuated and explained by genetic factors. The first year, they had 12.24 (CI: 8.11-18.46) times the risk of disability pension. The risk was attenuated but remained at 2.75 (CI: 2.07-3.65) after one year. The risk of unemployment was 1.99 (CI: 1.72-2.31) during the whole follow-up period. The risk of unemployment and disability pension was lower for those with stress-related than other mental disorders, this was less clear for recurrent reoccuring sick-leave.

CONCLUSIONS

Sick leave due to mental disorders increased the risk of reoccurring sick-leave within two years, disability pension and unemployment, independent of genetics and shared environment.

An Underlying Common Factor, Influenced by Genetics and Unique Environment, Explains the Covariation Between Major Depressive Disorder, Generalized Anxiety Disorder, and Burnout: A Swedish Twin Study

Depression and anxiety are highly comorbid due to shared genetic risk factors, but less is known about whether burnout shares these risk factors. We aimed to examine whether the covariation between major depressive disorder (MDD), generalized anxiety disorder (GAD), and burnout is explained by common genetic and/or environmental factors. This cross-sectional study included 25,378 Swedish twins responding to a survey in 2005-2006. Structural equation models were used to analyze whether the trait variances and covariances were due to additive genetics, non-additive genetics, shared environment, and unique environment. Univariate analyses tested sex limitation models and multivariate analysis tested Cholesky, independent pathway, and common pathway models. The phenotypic correlations were 0.71 (0.69-0.74) between MDD and GAD, 0.58 (0.56-0.60) between MDD and burnout, and 0.53 (0.50-0.56) between GAD and burnout. Heritabilities were 45% for MDD, 49% for GAD, and 38% for burnout; no statistically significant sex differences were found. A common pathway model was chosen as the final model. The common factor was influenced by genetics (58%) and unique environment (42%), and explained 77% of the variation in MDD, 69% in GAD, and 44% in burnout. GAD and burnout had additive genetic factors unique to the phenotypes (11% each), while MDD did not. Unique environment explained 23% of the variability in MDD, 20% in GAD, and 45% in burnout. In conclusion, the covariation was explained by an underlying common factor, largely influenced by genetics. Burnout was to a large degree influenced by unique environmental factors not shared with MDD and GAD.