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- Koppner, Jenny, 1973-
(author)
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Stress and mental health in populations of societies exposed to extraordinary circumstances : with focus on perceived and biological stress, perceived health, psychosocial factors, and sense of coherence
- 2024
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Doctoral thesis (other academic/artistic)abstract
- As our societies have grown larger, and communications have become global and fast-paced, our bodies and minds have been subjected to a mental stress different from the "fight or flight" situations we have adapted to through evolution. Furthermore, mental health issues are now seen to be on the rise all over the world. Globalisation has enabled social crises of different origins, e.g. financial or biological, to influence nations worldwide and spread faster than ever before. This thesis aims to investigate how populations are affected in regard to stress and mental health by the extraordinary circumstances of the global financial crisis of 2008 and the COVID-19 pandemic of 2020-2023.The first two studies in this thesis focus on the effects of the financial crisis on young adults (Paper I) and adults in working ages (Paper II). Greece was severely affected by the global financial crisis of 2008 and went into a decade long recession, whereas Scandinavian countries were less affected. University students were recruited from the psychology and medicine programs in Athens, Greece and Linköping, Sweden. Primary care visitors were recruited consecutively at primary health care centres (PHCC) in Greece, Sweden, and Norway. Data was collected in connection to recruitment. All participants filled out the same short questionnaire and gave hair samples that were analysed for cortisol concentrations (HCC) as a biological measure of stress.Papers III and IV are based on the Healthy OLD-study and investigate mental health, stress, and coping in older adults (70-80 years) during the COVID-19 pandemic. This age group was particularly vulnerable to the virus and therefore subjected to protective restrictions like social isolation. Participants were randomly recruited from five PHCC in south-east Sweden. Data was collected during one visit at the participant’s own PHCC and consisted of a comprehensive questionnaire, biometrics, and samples of blood, hair, and saliva. In Paper III only the questionnaire was used, and in Paper IV both the questionnaire and hair samples (analysed for HCC) were used.In Papers I and II the Greek participants reported a significantly higher occurrence of self-reported stress, anxiety, and depressive symptoms than their Swedish/Scandinavian peers. They also experienced more serious life events, and less hope for the future. In Paper I, cortisol levels were significantly lower for the Greek participants than the Swedish, which could indicate a fatigued Hypothalamic-Pituitary-Adrenal (HPA) axis due to longterm stress exposure, and/or genetic differences, and/or cultural differences. However, there was no significant difference in cortisol values between adults in working ages for Greeks and Scandinavians in Paper II, although significantly poorer overall health was reported in the Greek population compared to the Scandinavian population in Paper II. The strongest predictors explaining self-reported poor health were being Greek and feeling hopeless about the future. The strongest predictors for high perceived stress were moderate and high anxiety, and moderate depression.In Paper III social distancing was the factor most participants found had affected them the most during the COVID-19 pandemic. The participants who stated they had suffered a decline in mental health due to the COVID-19 pandemic reported more anxiety, depression, and stress than the participants who stated they had not been affected mentally. Risk factors for experiencing deteriorating mental health due to the pandemic were found to be a negative change in social life, experiencing a bad family situation, a change in physical activity, anxiety, and being a woman.In Paper IV, a low sense of coherence was significantly associated with anxiety, self-reported poor financial status, little belief in the future, and perceived negative mental effect from the COVID-19 pandemic. Anxiety was found to be a possible mediator between being mentally affected and sense of coherence. No association was found between sense of coherence and hair cortisol levels in this study. In general, women reported poorer mental health and quality of life than men, but there was no significant difference in hair cortisol levels.To conclude, the findings of this thesis show a high occurrence of stress, anxiety, and depression in adults living in societies exposed to financial crisis or the COVID-19 pandemic. Symptoms of anxiety and depression were shown to be predictors of high levels of perceived stress in young adults. Anxiety was especially prominent in older adults during the pandemic and is suggested to be a mediator in the association between sense of coherence (SoC) and participants who reported a decline in mental health due to the pandemic. A multitude of psychosocial factors were strongly correlated with SoC, respectively those mentally affected by the pandemic. Young Greek adults presented with lower HCC than their Swedish peers, which could be caused by fatigue of the HPA axis due to long-term stress exposure.The aim of this thesis does not have a direct clinical application, but the high occurrence of mental health issues, especially anxiety, found among adults living in societies exposed to extreme events emphasizes the importance of actively asking a patient how he/she is affected by a difficult life event, not least older women.
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- Norlin, Anna-Karin, 1977-
(author)
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Exploring the Biopsychosocial Model in Irritable Bowel Syndrome : with emphasis on stress, comorbidities and fatigue
- 2020
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Doctoral thesis (other academic/artistic)abstract
- BackgroundIrritable bowel syndrome (IBS) is a common, chronic, relapsing, and sometimes disabling, symptombased disorder of gut brain interactions. It has got a female predominance and occurs in all ages, with a slight decrease among elderly. The IBS symptoms can affect everyday work and social life in addition to an increased use of health care resources. Most IBS patients are diagnosed and helped in primary health care (PHC). For many patients, available treatment is insufficient. It is known that both extraintestinal symptoms such as fatigue, as well as comorbidities such as mood disorders, chronic pain syndromes, and insomnia contribute to the illness burden, often to a larger extent than the gastrointestinal symptoms as such.Even though the pathophysiology of IBS is not completely known, it is now conceptualized as a disorder of altered brain-gut interactions, where a biopsychosocial model helps in understanding the symptoms. Exposure to stress is thought to play an important role overall in the pathology of IBS, as well as immune activation at least in a subgroup of patients.This thesis aimed to gain deeper understanding of the biopsychosocial mechanisms of IBS and its associations with stress, comorbidities, and fatigue.Methods Study I and II are based on the Twin cities IBS study population, which included IBS patients and a control group of other patients without gastrointestinal complaints from ten PHC centres in the county of Östergötland. Alongside demographics, psychosocial questionnaires and a GI symptom diary, it included analyses of hair cortisol concentrations (HCC) evaluated in study I, and data on self-rated health as well as diagnoses of comorbidities, and number of health care contacts from a regional registry, evaluated for study II.Study III of this thesis is based on the Brain-Gut study with a population of secondary care IBS patients, and healthy controls (HC). It included self-rated measures of fatigue impact on the daily life and early adverse life events, as well as measures of circulating TNF-α, and analyses of resting-state functional magnetic resonance imaging of brain areas within a mesocorticolimbic circuitry of known relevance for fatigue.Results Study I: Perceived stress was higher in the IBS group while a considerable portion of IBS patients had low levels of HCC. No association between perceived stress and HCC was seen in either group.Study II: IBS patients had lower self-rated health and more PHC utilization than the non-IBS patients. Good self-rated health was independently associated with younger age, higher sense of coherence and less gastrointestinal pain in both groups. In IBS, PHC utilization was associated with comorbidities in general, and sleep disorders in particular.Study III: Fatigue impact on daily life, and TNF- α were higher in IBS patients than in HC. In IBS, further an association was seen between fatigue impact on the one hand, and TNF- α, emotional abuse in childhood, as well as altered mesocorticolimbic connectivity on the other.Conclusion In conclusion this thesis firstly emphasizes that IBS patients in many ways, including health outcomes, consists a vulnerable group of PHC patients. We add evidence for a possible suppression of the stress response system in a substantial portion of IBS patients.Further, comorbid sleep disorders seem to be particularly associated with excess PHC utilization in IBS and could possibly be a target for treatment interventions. Moreover, alongside treating gastrointestinal pain, efforts to improve the individuals’ sense of coherence could be one way to achieve better self-rated health in both IBS and non-IBS patients.Finally, we suggest that fatigue in IBS is associated with immune activation, central alterations and to some extend also previous childhood trauma.
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