Health-related quality of life in patients with Burnout

Int Arch Occup Environ Health DOI 10.1007/s00420-015-1075-5

ORIGINAL ARTICLE

Health‑related quality of life in patients with Burnout on sick leave: descriptive and comparative results from a clinical study Astrid Grensman1 · Bikash Dev Acharya1 · Per Wändell1 · Gunnar Nilsson1 · Sigbritt Werner2 

Received: 16 September 2014 / Accepted: 7 July 2015 © Springer-Verlag Berlin Heidelberg 2015

Abstract  Purpose  To explore the health-related quality of life (HRQoL), the cause of being ill, and the pharmacological treatment in patients on sick leave because of Burnout. The HRQoL among these patients was also compared with that of individuals who were working full time. Methods  HRQoL was measured using the SWED-QUAL questionnaire, comprising 67 items grouped into 13 subscales, scored from 0 (worst) to 100 (best) points, and covering aspects of physical and emotional well-being, cognitive function, sleep, general health, social, and sexual functioning. The Burnout group (n  = 94), mean age 43 years, were on 50 % sick leave or more. The comparison group consisted of healthy persons (n = 88) of similar age and educational level who were working full time. Results  The Burnout group had markedly low scores in general. The cause of illness was mainly work-related. Psychotropic medication was prescribed for 55 %. Significantly lower scores were found in the Burnout group than in the comparison group in all subscales, p 9–12 years  >12 years Having a partner (%) Medicationb, psychotropic drugs prescribed (%) Antidepressants, ATC NO6 Sleep medication and tranquilizers, ATC NO5

43.7 ± 0.97

40.0 ± 1.1

2 24 74 61 55 42 27

3 24 73 69 0

Pain killers, ATC NO2

4

17 46 36 ~10

a   The official Swedish population statistics in 2003–2008 from The National Board of Health and Welfare, and The National Social Insurance Board and Statistics, Sweden, are included for comparison in this table b

  ATC code NO6, antidepressants; ATC code N05, sleep medication and tranquillizers, and ATC code NO2, pain killers

Table 3  Characteristics of subscales in SWED-QUAL 1.0 Subscale

Number of items Description

Physical functioning

7

Satisfaction with physical functioning Pain, frequency, and intensity

1 6

Role limitation due to physical health Role limitation due to emotional health Positive affect Negative affect Cognitive function Sleep quality General health perceptions Satisfaction with family functioning

3 3 6 6 6 7 8 4

Satisfaction with partner functioning

6

Sexual functioning

5

Extent to which health interferes with ability to perform physical activities (e.g., heavy manual work, sports, climbing stairs, dressing) Satisfaction with physical ability to do what wanted Pain frequency, intensity, and interference with activities of daily life (ADL), sleep, and mood Extent to which physical problems interfere with ADL Extent to which emotional problems interfere with ADL Is a happy person, felt liked, emotionally in harmony, much to look forward to Felt nervous, tense, down, sad, impatient, annoyed Concentration, memory, capacity to take decisions, confusion Problems with sleep initiation and maintenance, sleep adequacy, and somnolence Health: prior and current, overall rating of health, immune defense, health worries Satisfaction with family life in terms of cohesiveness, amount of support and understanding, amount of talking things over, overall happiness with family life Relation to spouse (or person felt closest to) in terms of saying anything wanted, sharing feelings, feeling close, being supportive Lack of interest, inability to enjoy sex, difficulty becoming aroused, having orgasm (women), getting maintaining an erection (men)

(Brorsson et al. 1993), in order to obtain a good overview of which areas of life were affected in these patients. The questionnaire was constructed to be used both in the general population and in people with all sorts of conditions. SWED-QUAL was developed from the American Medical Outcome Study, as was the Short Form (SF-36) (Ware 2000), but SWED-QUAL is more extensive than SF-36 and explores HRQoL from a wider perspective. SWED-QUAL consists of 67 self-assessment questions about the present situation (now or during the past week) grouped into 13 separate subscales (12 multi-item scales and one 1-item

13

scale; Table 3). Besides questions on physical and emotional well-being, the questionnaire contains several questions about social interaction with partner and family, sleep, cognitive function, and sexual functioning, dimensions of HRQoL that are likely to be affected in Burnout. Furthermore, in SWED-QUAL, each subscale forms its own index, which facilitates evaluation and comparison in the included domains (Table 3). The questions are negatively or positively formulated with four alternative answers such as No, not at all = 1; Yes, slightly = 2; Yes, fairly much = 3; or Yes, very much = 4. For some of the items, a Likert scale

Int Arch Occup Environ Health

is used with answers ranging from completely agree = 4 to completely disagree = 1. The items in each scale are summed together, and the mean is linearly transformed into a health index, 0–100 for each scale with 0 as the worst and 100 as the best health. In addition, five items such as gender, age, having a partner or not, marital status/cohabiting, and education level are included in the questionnaire. The HRQoL questionnaire was self-completed directly into the database, either at the time of the interview or later on via a computer link, using a personal code. Diagnostic procedures, pharmacological treatment, cause of being sick, and sick leave Medication and cause of being sick were self-reported, and sick leave was reported by medical certificate, all at the interview. The patients underwent a psychological examination by a physician and a certified psychotherapist to establish the diagnosis of Exhaustion Syndrome and to assess psychiatric comorbidity, and they were clinically examined as well. The diagnostic interview was based on the structured clinical interview for DSM-IV, axis II (WHO 2010). Statistical methods A Bonett–Price 95 % confidence interval and median were calculated (Bonett and Price 2002). Also, Bonett-Price calculation for differences in medians was used to compare the subscale scores of the Burnout group with the subscale scores of the healthy comparison group to establish whether there were significant differences in scores. The significance level chosen was