title: Prevalence of perceived stress and associations to symptoms of exhaustion, depression and anxiety in a working age population seeking primary care--an observational study.
abstract: BACKGROUND
  Prolonged stress may lead to mental illness, but the prevalence of stress in a working age population seeking primary health care for whatever reason, is unknown. This paper seeks to examine to what extent this group perceives stress, as well as symptoms of burnout/exhaustion, depression and anxiety.
  
  
  METHODS
  In 2009, 587 primary health care patients aged 18-65 years (377 women, 210 men), with an appointment with a primary health care physician, participated in the study. A screening questionnaire with questions about age, gender, marital status, employment, reason for medical consultation, and the QPS Nordic screening question about stress was distributed:" Stress is defined as a condition where you feel tense, restless, anxious or worried or cannot sleep at night because you think of problems all the time. Do you feel that kind of stress these days? There were five possible answers; "not at all" and "only a little" (level 1),"to some extent" (level 2),"rather much" and "very much" (level 3). In a second step, symptoms of burnout/exhaustion (Shirom-Melamed Burnout Questionnaire and the Self-rated Exhaustion Disorder instrument) and anxiety/depression (Hospital Depression and Anxiety scale) were assessed among those with higher levels of perceived stress.
  
  
  RESULTS
  345 (59%) of the study patients indicated stress levels 2 or 3 (237 women and 108 men). Women more often indicated increased levels of stress than men. Two thirds of the participants expressing stress levels 2-3 indicated a high degree of burnout, and approximately half of them indicated Exhaustion Disorder (ED). Among highly stressed patients (level 3), 33% reported symptoms indicating possible depression and 64% possible anxiety.
  
  
  CONCLUSIONS
  More than half of this working age population perceived more than a little stress, as defined, women to a greater extent than men. Symptoms of burnout and exhaustion were common. A high level of perceived stress was often accompanied by symptoms of depression and/or anxiety.
authors.affiliation: Institute of Medicine, Department of Public Health and Community Medicine, The Sahlgrenska Academy at Gothenburg University, Box 454, SE-40530, Gothenburg, Sweden. lilian.wiegner@vgregion.se.|Institute of Stress Medicine (ISM), Carl Skottbergs gata 22 B, SE- 413 19, Gothenburg, Sweden. lilian.wiegner@vgregion.se.
authors.forename: Lilian
authors.initials: L
authors.lastname: Wiegner
authors.affiliation: Institute of Medicine, Department of Public Health and Community Medicine, The Sahlgrenska Academy at Gothenburg University, Box 454, SE-40530, Gothenburg, Sweden. dominique.hange@vgregion.se.
authors.forename: Dominique
authors.initials: D
authors.lastname: Hange
authors.affiliation: Institute of Medicine, Department of Public Health and Community Medicine, The Sahlgrenska Academy at Gothenburg University, Box 454, SE-40530, Gothenburg, Sweden. cecilia.bjorkelund@allmed.gu.se.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Björkelund
authors.affiliation: Institute of Stress Medicine (ISM), Carl Skottbergs gata 22 B, SE- 413 19, Gothenburg, Sweden. gunnar.ahlborg@vgregion.se.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Ahlborg
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology; D002055:Burnout, Professional / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care; D013315:Stress, Psychological / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D055815:Young Adult