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      Changes in mental health in compliers and non-compliers with physical activity recommendations in patients with stress-related exhaustion

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          Abstract

          Background

          There is a lack of research regarding the long-lasting effects of a more physically active lifestyle in patients with mental disorders. In the present study, clinical data were analysed to examine if initially physically inactive patients, clinically diagnosed with stress-related exhaustion, taking part in 12-month multimodal treatment (MMT), differ at the 18-month follow-up regarding mental health, depending on whether they did or did not comply with the physical activity (PA) recommendations resembling those of the American College of Sports Medicine.

          Methods

          The study population consisted of 69 patients (65 % women) who were referred to a stress clinic due to stress-related exhaustion. All patients received MMT. A major goal was to increase patients’ PA levels. The patients received general comprehensive instructions including personal advice regarding the positive effects of PA on mental health and could self-select for an 18-week coached exercise program. Changes in mental health symptoms over an 18-month period were compared between non-compliers ( n = 26), mild compliers ( n = 22) and strong compliers ( n = 21) with the PA recommendations included in the MMT.

          Results

          Non-compliers, mild and strong compliers did not differ regarding burnout, depression and anxiety at baseline. Although substantial improvements occurred in all groups, mild and strong compliers reported significantly lower burnout and depression levels at the 18-month follow-up than the non-complying group ( p < .05). The general pattern of findings was corroborated, if standard cut-off criteria for clinical burnout were used.

          Conclusions

          Compliance with PA recommendations is associated with decreased levels of burnout and depression in patients with stress-related exhaustion. Thus, the promotion of a more active lifestyle among patients with stress-related exhaustion should be implemented as a part of MMT, to achieve a more sustainable decrease of symptoms of burnout and depression.

          Trial registration

          This is not a clinical trial.

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          Most cited references43

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          Limits to the measurement of habitual physical activity by questionnaires.

          Despite extensive use over 40 years, physical activity questionnaires still show limited reliability and validity. Measurements have value in indicating conditions where an increase in physical activity would be beneficial and in monitoring changes in population activity. However, attempts at detailed interpretation in terms of exercise dosage and the extent of resulting health benefits seem premature. Such usage may become possible through the development of standardised instruments that will record the low intensity activities typical of sedentary societies, and will ascribe consistent biological meaning to terms such as light, moderate, and heavy exercise.
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            International experiences with the Hospital Anxiety and Depression Scale--a review of validation data and clinical results.

            More than 200 published studies from most medical settings worldwide have reported experiences with the Hospital Anxiety and Depression Scale (HADS) which was specifically developed by Zigmond and Snaith for use with physically ill patients. Although introduced in 1983, there is still no comprehensive documentation of its psychometric properties. The present review summarizes available data on reliability and validity and gives an overview of clinical studies conducted with this instrument and their most important findings. The HADS gives clinically meaningful results as a psychological screening tool, in clinical group comparisons and in correlational studies with several aspects of disease and quality of life. It is sensitive to changes both during the course of diseases and in response to psychotherapeutic and psychopharmacological intervention. Finally, HADS scores predict psychosocial and possibly also physical outcome.
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              Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians? diagnoses

              The aim of this study was to compare the validity of the Hospital Anxiety and Depression Scale (HADS), the WHO (five) Well Being Index (WBI-5), the Patient Health Questionnaire (PHQ), and physicians' recognition of depressive disorders, and to recommend specific cut-off points for clinical decision making. A total of 501 outpatients completed each of the three depression screening questionnaires and received the Structured Clinical Interview for DSM-IV (SCID) as the criterion standard. In addition, treating physicians were asked to give their psychiatric diagnoses. Criterion validity and Receiver Operating Characteristics (ROC) were determined. Areas under the curves (AUCs) were compared statistically. All depression scales showed excellent internal consistencies (Cronbach's alpha: 0.85-0.90). For 'major depressive disorder', the operating characteristics of the PHQ were significantly superior to both the HADS and the WBI-5. For 'any depressive disorder', the PHQ showed again the best operating characteristics but the overall difference did not reach statistical significance at the 5% level. Cut-off points that can be recommended for the screening of 'major depressive disorder' had sensitivities of 98% (PHQ), 94% (WBI-5), and 85% (HADS). Corresponding specificities were 80% (PHQ), 78% (WBI-5), and 76% (HADS). In contrast, physicians' recognition of 'major depressive disorder' was poor (sensitivity, 40%; specificity, 87%). Our sample may not be representative of medical outpatients, but sensitivity and specificity are independent of disorder prevalence. All three questionnaires performed well in depression screening, but significant differences in criterion validity existed. These results may be helpful in the selection of questionnaires and cut-off points.
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                Author and article information

                Contributors
                agneta.lindegard@vgregion.se
                ingibjorg.jonsdottir@vgregion.se
                mats.borjesson@ki.se
                magnus.lindwall@psy.gu.se
                0041 61 377 87 83 , markus.gerber@unibas.ch
                Journal
                BMC Psychiatry
                BMC Psychiatry
                BMC Psychiatry
                BioMed Central (London )
                1471-244X
                4 November 2015
                4 November 2015
                2015
                : 15
                : 272
                Affiliations
                [ ]Institute of Stress Medicine, Carl Skottsbergs gata 22B, Gothenburg, SE-41319 Sweden
                [ ]Department of Food and Nutrition, and Sport Science, University of Gothenburg, PO Box 300, Gothenburg, SE-40530 Sweden
                [ ]The Swedish School of Sport and Health Sciences, University of Stockholm, Lidingövägen 1, Stockholm 1, SE-11433 Sweden
                [ ]Department of Cardiology, Karolinska University Hospital, Stockholm, SE-17176 Sweden
                [ ]Department of Psychology, University of Gothenburg, PO Box 500, Gothenburg, SE-40530 Sweden
                [ ]Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320B, Basel, CH-4052 Switzerland
                Article
                642
                10.1186/s12888-015-0642-3
                4632342
                26530329
                d7479215-841b-4ead-983d-863bcf00ab21
                © Lindegård et al. 2015

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 12 June 2015
                : 8 October 2015
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2015

                Clinical Psychology & Psychiatry
                anxiety,burnout,compliance,depression,physical activity,stress-related exhaustion

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