Papers by Aleksander Perski
Scandinavian journal of psychology, Jan 23, 2015
The aim of this paper was to provide an overview of the literature on clinically significant burn... more The aim of this paper was to provide an overview of the literature on clinically significant burnout, focusing on its assessment, associations with sleep disturbances, cognitive impairments, as well as neurobiological and physiological correlates. Fifty-nine English language articles and six book chapters were included. The results indicate that exhaustion disorder (ED), as described in the Swedish version of the International Classification of Diseases, seems to be the most valid clinical equivalent of burnout. The data supports the notion that sleep impairments are causative and maintaining factors for this condition. Patients with clinical burnout/ED suffer from cognitive impairments in the areas of memory and executive functioning. The studies on neuro-biological mechanisms have reported functional uncoupling of networks relating the limbic system to the pre-frontal cortex, and decreased volumes of structures within the basal ganglia. Although there is a growing body of literatu...
Current Directions in Psychological Science
Sleep, 2010
Short sleep duration is associated with increased CHD (coronary heart disease) mortality and morb... more Short sleep duration is associated with increased CHD (coronary heart disease) mortality and morbidity, although some evidence suggests that sleep disturbance is just as important. We investigated whether a combination of short sleep duration and sleep disturbance is associated with a higher risk of CHD than their additive effects. The Whitehall II study. The Whitehall II study recruited 10,308 participants from 20 civil service departments in London, England. Participants were between the ages of 35 and 55 years at baseline (1985-1988) and were followed up for an average of 15 years. N/A. Sleep hours and sleep disturbance (from the General Heath Questionnaire-30) were obtained from the baseline survey. CHD events included fatal CHD deaths or incident nonfatal myocardial infarction or angina (ICD-9 codes 410-414 or ICD-10 120-25). Short sleep duration and sleep disturbance were both associated with increased hazards for CHD in women as well as in men, although, after we adjusted for...
Läkartidningen, Jan 2, 2002
This cross-sectional investigation aimed at assessing levels of emotional exhaustion among female... more This cross-sectional investigation aimed at assessing levels of emotional exhaustion among female employees within the Swedish public sector. Other aims were to study the associations between self-rated emotional exhaustion and psychosocial factors at work, as well as findings from medical examinations. Data was collected by means of questionnaires including the Maslach Burnout Inventory, among 183 women working in geriatric care and 143 employees at the National Social Insurance Office. We found high proportions of emotional exhaustion in both samples (geriatric care = 34%; Social Insurance Office = 26%). Participants with high scores for emotional exhaustion reported more job-strain, less social support at work and more somatic, emotional and cognitive complaints than those with low or intermediate scores. Medical examinations performed on 19 participants with low scores and 41 with high scores for emotional exhaustion revealed significantly more findings among participants with h...
PloS one, 2014
Despite mounting reports about the negative effects of chronic occupational stress on cognitive a... more Despite mounting reports about the negative effects of chronic occupational stress on cognitive and emotional functions, the underlying mechanisms are unknown. Recent findings from structural MRI raise the question whether this condition could be associated with a functional uncoupling of the limbic networks and an impaired modulation of emotional stress. To address this, 40 subjects suffering from burnout symptoms attributed to chronic occupational stress and 70 controls were investigated using resting state functional MRI. The participants' ability to up- regulate, down-regulate, and maintain emotion was evaluated by recording their acoustic startle response while viewing neutral and negatively loaded images. Functional connectivity was calculated from amygdala seed regions, using explorative linear correlation analysis. Stressed subjects were less capable of down-regulating negative emotion, but had normal acoustic startle responses when asked to up-regulate or maintain emoti...
BMC Public Health, 2014
Background: Stress-related mental disorders rank among the leading causes of sickness absence in ... more Background: Stress-related mental disorders rank among the leading causes of sickness absence in several European countries. The aim of this study was to investigate predictors of all-cause and diagnosis-specific disability pension in sickness absentees with stress-related mental disorders.
Nordic Journal of Psychiatry, 2014
Background: Insomnia-type sleep disturbances are frequent among patients suffering from stress-re... more Background: Insomnia-type sleep disturbances are frequent among patients suffering from stress-related exhaustion disorder. However, clinical observations indicate that a subgroup suffer from sleep lengths frequently exceeding 9 hours, coupled with great daytime sleepiness. Aims: The aim of the present study was to investigate differences in socio-demographic variables, use of medications, sleep parameters, anxiety, depression and fatigue, between individuals with varying sleep lengths, in a sample of 420 Swedish patients (mean age 42 ± 9 years; 77% women) referred to treatment for exhaustion disorder. Patients were allocated to the groups: "never/seldom ≥ 9 hours" (n = 248), "sometimes ≥ 9 hours" (n = 115) and "mostly/always ≥ 9 hours" (n = 57), based on their self-rated frequency of sleep lengths ≥ 9 hours. Methods: The design was cross-sectional and data was collected by means of questionnaires at pre-treatment. Results: Univariate analyses showed that patients in the "mostly/always ≥ 9 hours" group were more often on sick leave, and reported more depression and fatigue, better sleep quality and more daytime sleepiness, than patients in the other groups. Multivariate analyses showed that these patients scored higher on measures of fatigue than the rest of the sample independently of gender, use of antidepressants, sick leave, depression and quality of sleep. Conclusions: Patients suffering from exhaustion disorder and reporting excessive sleep seem to have a generally poorer clinical picture but better quality of sleep than their counterparts with shorter sleep lengths. The mechanisms underlying these differences, together with their prognostic value and implications for treatment remain to be elucidated in future studies.
Journal of Educational and Developmental Psychology, 2012
Chronic stress has been associated with severe stress-related symptoms not only among adults but ... more Chronic stress has been associated with severe stress-related symptoms not only among adults but also among adolescents. The aim of the study was to investigate if chronic stress has implications for adolescents' academic achievement. 270 high school students answered a questionnaire on stress symptoms on two occasions, at the beginning and at the end of high school. Those who perceived severe stress symptoms at both time points finished high school with significantly worse final grades than those who reported experiencing stress at only one or none of the time points. The risk for chronic stress was increased among adolescents with low global self-esteem, who perceived high demands and reported their self-rated health to be poor and their sleep duration to be insufficient. The results suggest that the early prevention of chronic stress is critical since, if left untreated, it can have serious consequences on young people's future health and career possibilities.
Stress and Cardiovascular Disease, 2011
ABSTRACT It is estimated that sleep problems affect around 20% of the adult population in the Wes... more ABSTRACT It is estimated that sleep problems affect around 20% of the adult population in the Western countries.1,2 It has been shown that the short-term consequences of sleep problems lead to adverse physiological changes,3 as well as to long-term health consequences. In experimental and epidemiological studies, both short and long sleep hours have been related to hypertension,4 type-2 diabetes,5,6 increased body mass index (BMI),7 alterations in blood lipids,8 and inflammatory markers9 – all factors known to increase the risk of cardiovascular disease. KeywordsBrain metabolism-Glucose changes-Heart disease-Rapid eye Âmovement sleep (REM)-Risk factors-Sleep-Sleep disorders-Stress
Work & Stress, 1990
... Several physiological variables showed the expected age trends: increasing levels with increa... more ... Several physiological variables showed the expected age trends: increasing levels with increasing age ... A few clear patterns are visible in the biomedical data controllers showed relatively low ... The observed differences between the groups do correspond to real differences in the ...
Scandinavian Journal of Work, Environment & Health, 2006
Ekstedt M, Söderström M, Åkerstedt T, Nilsson J, Søndergaard H-P, Aleksander P. Disturbed sleep a... more Ekstedt M, Söderström M, Åkerstedt T, Nilsson J, Søndergaard H-P, Aleksander P. Disturbed sleep and fatigue in occupational burnout. Scand J Work Environ Health 2006;32(2):121-131.
Scandinavian Journal of Work, Environment & Health, 1988
A sample of 73 men and women aged 22-63 years and working in six different occupations (air traff... more A sample of 73 men and women aged 22-63 years and working in six different occupations (air traffic controllers, waiters, physicians, symphony orchestra musicians, baggage handlers, and airplane mechanics) participated in a longitudinal study four times during a year. The spontaneous variations in job strain (determined as the self-reported ratio between psychological demands and decision latitude) were substantial. The average difference between the occasion with the highest level of strain and the occasion with the lowest level was 25% of the total mean. Systolic blood pressure during workhours, as well as self-reported sleep disturbance, increased when demands increased in relation to decision latitude. Among men with a depressive tendency (according to a diary) morning plasma prolactin levels increased markedly with increasing job strain. Among subjects with a positive family history of hypertension the increase in systolic blood pressure at work was particularly pronounced, and among the men in this group a lower than expected level of morning cortisol was found measured during the period with the highest level of strain.
Scandinavian Journal of Public Health, 2012
Scandinavian Journal of Caring Sciences, 1999
In an interview conducted one year after coronary bypass surgery (CABG), 115 patients (92 males, ... more In an interview conducted one year after coronary bypass surgery (CABG), 115 patients (92 males, 23 females) were asked to discuss their present quality of life, problems related to the operation and their reactions to the supportive care following the operation. The main purpose of this study was to assess whether the patients' own presentation of these questions revealed information not elucidated through a standard questionnaire which included the Nottingham Health Profile and other questions on physical, emotional and social well-being. About one quarter of the interviewed patients expressed dissatisfaction concerning their present quality of life, information which corresponded well with the findings in the questionnaires. Reported limitation in physical activity did not, however, match exercise test findings. The interviews alone revealed additional information concerning well-being. Most important were problems with wound healing and difficulties describing and interpreting pain and other discomfort in the thoracic area. Several patients also expressed dissatisfaction with the postoperative supportive care. We conclude that there is a need for a complementary approach to estimate quality of life, and that this could be included in an extended nursing care program designed to meet the varying needs of patients after CABG.
Scandinavian Journal of Caring Sciences, 2013
Psychosomatic Medicine, 1999
This study was conducted to investigate associations between psychosocial risk factors, including... more This study was conducted to investigate associations between psychosocial risk factors, including social isolation, anger and depressive symptoms, and heart rate variability in healthy women. The study group consisted of 300 healthy women (median age 57.5 years) who were representative of women living in the greater Stockholm area. For the measurement of social isolation, a condensed version of the Interpersonal Support Evaluation List was used and household size assessed. Anger was measured by the anger scales previously used in the Framingham study and depressive symptoms by a questionnaire derived from Pearlin. Health behaviors were measured by means of standard questionnaires. From 24-hour ambulatory electrocardiographic monitoring, both time and frequency domain measures were obtained: SDNN index (mean of the SDs of all normal to normal intervals for all 5-minute segments of the entire recording), VLF power (very low frequency power), LF power (low frequency power), HF power (high frequency power), and the LF/HF ratio (low frequency by high frequency ratio) were computed. Social isolation and inability to relieve anger by talking to others were associated with decreased heart rate variability. Depressive symptoms were related only to the LF/HF ratio. Adjusting for age, menopausal status, exercise and smoking habits, history of hypertension, and BMI did not substantially change the results. These findings suggest heart rate variability to be a mediating mechanism that could explain at least part of the reported associations between social isolation, suppressed anger, and health outcomes.
PLoS ONE, 2013
There are increasing reports of cognitive and psychological declines related to occupational stre... more There are increasing reports of cognitive and psychological declines related to occupational stress in subjects without psychiatric premorbidity or major life trauma. The underlying neurobiology is unknown, and many question the notion that the described disabilities represent a medical condition. Using PET we recently found that persons suffering from chronic occupational stress had limbic reductions in the 5-HT1A receptor binding potential. Here we examine whether chronic work-related stress is also associated with changes in brain structure. We performed MRI-based voxel-based morphometry and structural volumetry in stressed subjects and unstressed controls focusing on gray (GM) and white matter (WM) volumes, and the volumes of hippocampus, caudate, and putamen -structures known to be susceptible to neurotoxic changes. Stressed subjects exhibited significant reductions in the GM volumes of the anterior cingulate cortex and the dorsolateral prefrontal cortex. Furthermore, their caudate and putamen volumes were reduced, and the volumes correlated inversely to the degree of perceived stress. Our results add to previous data on chronic psychosocial stress, and indicate a morphological involvement of the frontostriatal circuits. The present findings of morphological changes in these regions confirm our previous conclusion that symptoms from occupational stress merit careful investigations and targeted treatment.
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Papers by Aleksander Perski