Neuropsychological sequelae of work-stress-related exhaustion

Figures & data

Table 1. Demographic characteristics of the participating former work-stress-related exhaustion patients (n = 54) and healthy controls (n = 50).

Characteristic	Patients	Controls
Age
Mean (SD)	49.7 (9.4)	49.9 (8.3)
Range	32–64	31–63
	n (%)
Gender
Men	15 (28)	13 (26)
Women	39 (72)	37 (74)
Education
Nine-year compulsory schooling	8 (15)	6 (12)
Upper secondary school	18 (33)	8 (16)
University studies	28 (52)	36 (72)
Supervisory position
Preceding sick-leave due to exhaustion	16 (30)	–
At follow-up	7 (18)*	10 (20)
Employment
Private sector	16 (30)	18 (36)
Public sector	38 (70)	32 (64)

*Figures based on those who had returned to work to any extent at follow-up (n = 38).

Table 2. Medical characteristics of the participants.

	Patients (n = 54)	Controls (n = 50)
Characteristic	n (%)
Somatic disorders, total	16 (30)	5 (10)
Hypertension (treated)	5 (9)	4 (8)
Type I diabetes	1 (2)	0
Type II diabetes	1 (2)	0
Other*	10 (19)	1(2)
Medication
Antidepressants; SSRI, SNRI or NaSSA †	22 (41)	0
Anxiolytics or sleeping pills	5 (9)	0
Medication for somatic disorders ‡	24 (44)	6 (12)
Hormonal replacements/contraceptives	8 (15)	12 (24)
No medication	13 (24)	33 (66)
Psychotherapy	12 (22)	0
Alcohol consumption
Low to moderate	53 (98)	50 (100)
High	1 (2)§	0
Prime-MD
Major depression	4 (7)¶	–
Mild depression or dysthymia	3 (6)**	–
Anxiety disorder	3 (6)	–
Anxiety disorder + major depression	6 (11)††	–
Somatization disorder only	4 (7)	–
Somatoform syndrome NUD only	6 (11)	–
BDI
Severe depression	7 (13)	0
Moderate depression	7 (13)	0
Slight depression	14 (26)	2 (4)
Minimal depression	26 (48)	48 (96)
	Mean (SD)
BDI total score (sum of 21 items)	13.2 (10.9)	3.3 (3.2)
SCL-90 subscale means
Anxiety (10 items)	1.1 (0.8)	0.4 (0.3)
Somatization (12 items)	1.0 (0.8)	0.3 (0.3)
Depression (13 items)	1.3 (0.9)	0.5 (0.5)

*Two patients had thyroid disorder (treated), and the other patients each had one of the following: airway allergy with sleep apnea (treated), ankylosing spondylitis, atrial fibrillation, endometriosis, gluten intolerance (treated), mineral deficiency (treated), recurrent diverticulitis and slight B12 deficiency (treated). One control had sleep apnea (treated).

†Selective serotonin reuptake inhibitor (SSRI), serotonin-norepinephrine reuptake inhibitor (SNRI) or noradrenergic and specific serotonergic antidepressant (NaSSA).

‡Mostly antihypertensive and antihyperlipidemic drugs and vitamin or mineral supplements.

§Refers to previous consumption; at follow-up this patient received treatment with acamprosate.

¶One patient also met the criteria for somatization disorder.

**One patient also met the criteria for somatoform syndrome NUD.

††Patients also met the criteria for: somatoform syndrome NUD (n = 2), somatization disorder (n = 2; one in combination with obsessive–compulsive disorder) and obsessive–compulsive disorder combined with social phobia (n = 1).

Prime-MD, Primary Care Evaluation of Mental Disorders (Spitzer et al., 1994); SCL-90, Symptom Checklist 90 (Derogatis, 1992); BDI, Beck Depression Inventory (BDI) (Beck et al., 1988).

Table 3. Neuropsychological test raw scores* for former work-stress-related exhaustion patients and healthy controls.

	Patients (n = 54)		Controls (n = 50)		ANOVA, Group
Cognitive domain and test	Mean	SD	Mean	SD	F†	p‡
Verbal intellectual ability
SRB:1 vocabulary	24.8	2.9	24.5	2.5	1.62	0.21^A,E	–
WAIS-R Information	22.6	3.5	22.2	3.2	2.30	0.13^E,G	–
F-A-S Verbal Fluency	44.5	10.2	47.5	10.6	2.68	0.11^E,G,P	–
Visuo-spatial constructional skills
Rey Complex Figure Test, copy	33.3	2.1	34.5	2.1	13.55	<0.001^A	0.118
Episodic memory
Cronholm–Molander verbal memory, immediate recall	24.6	4.0	23.4	4.3	4.77	0.031^A,E,G	0.046
- -             delayed recall	19.7	6.2	18.5	5.0	3.07	0.08^A,E,G	–
Austin Maze§, total errors¶	29.8	17.2	29.9	14.3	<0.01	0.98^A	–
- -    total performance time (s)¶	293	103	296	102	0.07	0.79^A,E,G	–
Incidental learning WAIS-R NI, number correct¶	6.6	2.1	5.7	2.4	5.34	0.023^A,E	0.051
Rey Complex Figure Test, immediate recall (3 min)	20.5	6.6	21.5	5.9	1.05	0.31^A	–
- -        delayed recall (30 min)	20.2	6.6	21.5	5.9	1.51	0.22^A	–
- -        recognition trial	20.7	1.7	20.4	2.1	1.30	0.26^A,E,G	–
Working memory
WAIS-R Digit Span, forward	7.5	2.3	7.1	2.2	0.83	0.37	–
- -     backward	7.2	2.2	7.5	2.3	0.18	0.67^E,G	–
Sustained attention and processing speed*
WAIS-R Digit Symbol	54.9	11.5	60.5	9.5	2.92	0.091^A,D,G	–
APT k-test, d′	4.10	0.41	4.16	0.42	0.46	0.50	–
- - β **	−0.77	0.66	−0.56	0.57	2.90	0.09^A,G	–
- - RT level for correct responses, left part of screen (ms)¶	1100	225	1025	190	0.06	0.80^A,D,E,G,P	–
- - RT level for correct responses, center part of screen (ms)¶	944	215	901	192	1.36	0.25^A	–
- - RT level for correct responses, right part of screen (ms)¶	1141	213	1100	237	0.28	0.60^A,D,G	–
- - search strategy††	0.58	0.07	0.54	0.08	6.20	0.014^A,G	0.058
- - error ratio (%)¶	2.3	2.2	1.9	2.2	1.61	0.21	–
APT RT-2,  level (ms)¶	348	72	308	38	5.50	0.021^A,D	0.052
- - variation (ms)¶	78	43	58	22	8.88	0.004^A,D	0.082
APT RT-Inhib, level (ms)¶	508	134	410	82	11.56	0.001^A,D,G	0.105
- -  variation (ms)¶	128	62	94	38	4.69	0.033^A,D	0.045
- -  error ratio (%)¶	6.7	6.2	7.4	5.8	0.61	0.44	–

*Scores for IVA and APT SimCap are presented in Tables 4 and 5, respectively.

†df ranged from [1,97] to [1,102].

‡Univariate ANOVA p values for between-group comparisons, corrected for age (A), Symptom Checklist-90 depression score (D), level of education (E), gender (G) and medication with psychopharmacological drugs (P) in case p < 0.20 for each covariate.

§n = 53 in the patient group; for one case, the Austin Maze data were excluded due to incomplete data.

¶A lower score signifies better performance.

**Qualitative variable; a negative β indicates that false rejections (missed “k”s) were relatively more common than false alarms (alarms when k not present).

††Qualitative variable; a lower value indicates a more sequential/obsessive search strategy, while a higher value indicates a more global/impulsive search strategy.

Table 4. IVA attention test scores for former work-stress-related exhaustion patients and healthy controls.

	Patients (n = 54)		Controls (n = 50)		ANOVA, Group
Main scales and subscales	Mean	SD	Mean	SD	F*	p†
Attention
Full Scale Attention Quotient	99.3	21.7	107.2	14.3	4.76	0.031^A	0.045
Speed, Auditory	120.8	13.8	126.4	12.9	1.32	0.25^A,D,G	–
- -  Visual	102.4	12.3	109.1	8.8	3.47	0.065^D,G	–
Vigilance, Auditory	97.1	20.0	100.9	13.5	1.68	0.20^A	–
- -   Visual	96.8	22.0	99.7	12.4	<0.01	0.99^A	–
Focus, Auditory	87.2	19.6	92.1	17.1	1.91	0.17^A	–
- -  Visual	94.9	21.1	101.6	15.9	3.33	0.071^A	–
Response control
Full Scale Response Control Quotient	88.9	22.0	97.4	18.2	4.83	0.030^A,G	0.046
Consistency, Auditory	85.3	20.8	94.9	15.3	5.75	0.018^A,E	0.054
- -    Visual	95.5	22.1	103.7	17.3	4.57	0.035^A,G	0.044
Prudence, Auditory	99.5	20.8	103.1	19.5	1.09	0.30	–
- -    Visual	93.8	23.4	92.9	21.2	0.57	0.45^A	–
Stamina, Auditory	96.4	19.8	100.9	19.3	4.33	0.040^D	0.041
- -  Visual	92.7	13.8	95.4	14.3	<0.01	0.96^P	–

*df ranged from [1,99] to [1,102].

†Univariate ANOVA p values for between-group comparisons, corrected for age (A), Symptom Checklist-90 depression score (D), level of education (E), gender (G) and medication with psychopharmacological drugs (P) in case p < 0.20 for each covariate.

Table 5. APT Simultaneous Capacity test raw scores for former work-stress-related exhaustion patients and healthy controls.

	Participants reaching level n (%)			Patients (n = 54)		Controls (n = 50)		ANOVA, Group
Difficulty	Patients	Controls	Variable	Mean	SD	Mean	SD	F*	p†
Level 1	54 (100)	50 (100)	d′	3.43	0.76	3.48	0.61	0.51	0.48^A,D	–
			β‡	2.43	0.74	2.66	0.83	6.03	0.016^A,D	0.057
			Corr. serviced messages (%)	87.5	11.8	90.3	7.9	1.97	0.16^A	–
			Spurious responses (%)§	1.37	3.59	0.52	1.80	0.16	0.69^D,E,G	–
Level 2	50 (93)	48 (96)	d′	3.06	0.63	3.14	0.48	0.26	0.61^A,D	–
			β‡	2.81	0.81	2.89	0.70	0.21	0.65^A,D,G	–
			Corr. serviced messages (%)	91.4	8.1	95.0	6.9	1.14	0.29^A,P	–
			Spurious responses (%)§	3.10	4.88	0.85	2.71	1.41	0.24^D,G,P	–
Level 3	24 (44)	31 (62)	d′	3.02	0.57	2.71	0.51	8.68	0.005^A,D	0.145
			β‡	2.67	0.72	2.68	0.70	0.08	0.78^D,P	–
			Corr. serviced messages (%)	76.7	15.4	75.8	13.0	0.11	0.75^A	–
			Spurious responses (%)§	8.96	6.53	10.19	8.68	0.25	0.62^A,E	–

*df ranged from [1,51] to [1,101].

†Univariate ANOVA p values for between-group comparisons, corrected for age (A), Symptom Checklist-90 depression score (D), level of education (E), gender (G) and medication with psychopharmacological drugs (P) in case p < 0.20 for each covariate.

‡Qualitative variable; a positive β indicates that false rejections (missed targets) was relatively more common than false alarms (responding to distractors).

§A lower score signifies better performance.

Table 6. Self-rated cognitive problems for former work-stress-related exhaustion patients and healthy controls.

					ANOVA, Group
	Patients (n = 54)		Controls (n = 50)		Unadjusted for covariates*			Adjusted for covariates*
Main scales and subscales	Mean	SD	Mean	SD	F †	p		F ‡	p
Euroquest memory and concentration problems§
Total mean score	2.43	0.67	1.80	0.47	29.7	<0.001	0.226	1.95	0.17^D,P	–
Concentration and attention  problems subscale	2.29	0.71	1.61	0.53	30.3	<0.001	0.229	1.58	0.21^D,P	–
Memory problems subscale	2.49	0.72	1.90	0.49	24.3	<0.001	0.192	1.67	0.20^D,P	–
5-item questionnaire of everyday memory problems§
Total mean score	3.52	0.75	2.69	0.49	44.1	<0.001	0.302	16.65	<0.001^D	0.142
1. Does anybody close to you  (family, friends) think you  have a poor memory?	2.98	1.06	2.24	0.87	15.1	<0.001	0.129	3.07	0.083^A,D,G	–
2. How is your memory today,  in comparison with your  memory 5 years ago?	4.22	0.74	3.52	0.50	31.3	<0.001	0.234	9.65	0.002^D	0.087
3. How do you perceive your  memory in comparison  with that of other persons  your age?	3.69	0.80	3.04	0.60	21.4	<0.001	0.173	7.08	0.009^D	0.066
4. Do you forget appointments  if not prompted by someone  else or by a reminder such as  a calendar or diary?	3.75	1.05	2.56	0.81	41.2	<0.001	0.289	18.79	<0.001^D,G	0.160
5. Does it occur that you do not  remember things that have  recently happened?	2.98	1.16	2.10	0.89	18.8	<0.001	0.156	13.39	0.032^D	0.045

*Univariate ANOVA p values for between-group comparisons, either unadjusted for covariates or adjusted for age (A), Symptom Checklist-90 depression score (D), gender (G) and medication with psychopharmacological drugs (P) in case p < 0.20 for each covariate.

†df = [1,102].

‡df ranged from [1,99] to [1,101].

§Higher scores represent poorer ratings.

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