Appropriate responsiveness to everyday-life stressors is crucial for adequate functioning in a natural environment. Conversely, depending on individual's genetic makeup, prolonged stress, coupled with inappropriate responsiveness may lead to physiological and psychiatric disorders. Various psychiatric conditions have been associated with stress and alterations in hypothalamic-pituitary-adrenal (HPA) activity. Yet while stress is a general phenomenon, illness is only seen in a proportion of individuals, suggesting genetic modifiers of ability to cope with stress. In children, relatively little research has been conducted to estimate the impact of genetic factors on the variability in HPA axis functioning.

In the present explorative investigation, 106 prepubertal children were studied to estimate the impact of four glucocorticoid receptor gene (NR3C1) polymorphisms (NR3C1-1, ER22/23EK, N363S, N766N) and five arginine vasopressin (AVP) receptor 1b gene (AVPR1b) polymorphisms (AVPR1b_s1, AVPR1b_s2, AVPR1b_s3, AVPR1b_s4, AVPR1b_s5) on cortisol responses after a psychosocial stress test (public speaking task).

ER22/23EK carriers displayed significant lower cortisol responses to psychosocial stress compared to noncarriers. This particular polymorphism has earlier been associated to the vulnerability to develop MDD by our own research group (1) and independently by another publication (2).

These findings support the relevance of the ER22/23EK polymorphism in HPA axis regulation and in the vulnerability for psychiatric disorders.

1. 1. van West D et al, Neuropsychopharmacology 31: 620-627, 2006.

2. 2. Van Rossum EFC et al., Biol Psychiatry 59: 681-688, 2006.

Physical and mental health has been found to be affected by occupational factors that cause psychological strain. The aim of this cross-sectional study was to investigate the Prevalence of risk for mental disorders among paramedical students at the Fatemeh nursing &Midwifery college in Iran.

The studied population included 184 paramedical students from First year and fourth year of education. Self-administered questionnaires were used to solicit demographic information and Psychological ill health was measured using a standard instrument—the General Health Questionnaire (GHQ 28). In this study a cut-off point of 23 was used for prevalence estimations. By this scoring, if the total score was 23 or less (from84) then the person was regarded healthy. The higher the GHQ-28 scores indicated the subject might suffer from a psychiatric distress.

The majority of the respondents (68.5%) were between the ages of 20-24 years and 80.8 % were female.47.3 percent of paramedical students had GHQ scores of 24 and above, indicating an increased likelihood of psychological disorder. The average score was 25.93 +/-14.93.Depression has the lowest mean score (3.92+/-7.2), while social dysfunction has the highest mean score (8.12+/-3.97) among the subscales. GHQ scores between the dissatisfied and satisfied groups were statistically significant (P = 0.001).

This study suggests that paramedical students have high levels of stress, so counseling and other support services should be made available to them.

Physical and mental health has been found to be affected by occupational factors that cause psychological strain. The aim of this cross-sectional study was to investigate the Prevalence of risk for mental disorders among paramedical students at the Fatemeh nursing &Midwifery college in Iran.

The studied population included 184 paramedical students from First year and fourth year of education. Self-administered questionnaires were used to solicit demographic information and Psychological ill health was measured using a standard instrument—the General Health Questionnaire (GHQ 28). In this study a cut-off point of 23 was used for prevalence estimations. By this scoring, if the total score was 23 or less (from84) then the person was regarded healthy. The higher the GHQ-28 scores indicated the subject might suffer from a psychiatric distress.

The majority of the respondents (68.5%) were between the ages of 20-24 years and 80.8 % were female.47.3 percent of paramedical students had GHQ scores of 24 and above, indicating an increased likelihood of psychological disorder. The average score was 25.93 +/-14.93.Depression has the lowest mean score (3.92+/-7.2), while social dysfunction has the highest mean score (8.12+/-3.97) among the subscales. GHQ scores between the dissatisfied and satisfied groups were statistically significant (P = 0.001).

This study suggests that paramedical students have high levels of stress, so counseling and other support services should be made available to them.

To determine whether the change in working conditions related to the privatisation of Primary Health Care increased stress among GPs and to obtain insight into the most prominent stressors.

Two questionnaires (the Holmes and Rache social readjustment questionnaire and a special test for investigating stressors derivered by the “emic” method) were used. SUBJECTS: 120 GPs with private practices (response rate of 75%) and 90 hospital doctors (response rate 92%).

2/3 of participants in both subgroups were females. In both subgroups, around 1/2 of participants were up to 45 years old. Significant findings were that 30.3% of GPs reported progress having been made regarding their working place and finances, 78.8% reported that their work responsibilities had increased and 57.6% reported that they had changed their working hours and work conditions. 24.2% of GP s reported a reduction in the time spent with their families, 6.1% stated that their children had altered their behaviour in a negative manner, 26.3% of GPs stated that their partners had altered their behaviour for the better and only 16.2% took time off for sickness in the last three years. The most common stressors found were disruption to family life due to consultation with patients after working hours (46.9% cases) and feeling overloaded with new administrative commitments (68.4% cases).

Privatisation of PHC produced stress among GPs without severe negative consequences to the private lives and health of GPs.

Kashmir, a predominantly Muslim society had lowest rates of suicide in whole India(0.5/100,000) but not any more, 17yrs of conflict has brought trauma and turmoil PTSD,MDD,SUBSTANCE USE are at all time high. Suicide is becoming the second common cause of unnatural death.

This study was based on data from, longititudinal medico legal registers of S.M.H.S Hospital.The registers were surveyed for all suicide, Para – suicide and deliberate self harm cases. Medical record number – a unique registration number – was used for identification of case files of suicide, Para suicide and deliberate self harm cases. The case files were then used to reflect on various socio – demographic variables and psychiatric assessments.

The result of the study reveals that on an average 3.5 persons report / day to SMHS causality with suicidal behavior. Most of the people who complete suicide are males of the age group 25 – 34. Most of the attempts are made by female- 4 times Para suicides and 7 times more DSH. . . Violent methods of suicide like cut throat and burns are a new phenomenon. All types of suicidal behavior are common in age group 25 – 34 except DSH in females were 63 % are in age group 19 – 24yrs

Suicide has arrived in an unlikely socioreligious scenario and perhaps taking all health planners unawares. And preventive strategies at all levels from primordial to primary to secondary to tertiary need to be taken to address this problem.

To demonstrate that stress can be seen as warning signals that the mind sends out when it's past experience and current capability to cope (determined by one's existing personality) is exceeded by the challenges in life. Accordingly, stress symptoms manifests when boundaries of one's personality – the way one thinks, feels, and act – is exceeded for the better as well as for the worse. The author has found that 'Breakthrough Intimacy' - closeness between committed couples far greater than their previous maximum level, can eliminate stress symptoms such as anxiety, anger, physical-symptoms, depression, and symptoms of borderline personality disorder, by exhaustion without medications and often within 6 months.

The patient and his/her partner perform daily subjective self-rating on 41 parameters to record daily changes in their psychological adjustment, according to a quantifiable model of personality and positive mental health. The couples' daily self-rating is tracked graphically via Internet, providing accurate and comprehensive data to guide the therapist and the patients. Working in three-way teamwork, the therapist actively help the couples to achieve closeness far greater than their previous maximum experience, overcoming waves of symptoms until they disappear by exhaustion, as the couple undergo personality transformation.

1,170 patients treated for various stress symptoms over the last 20 years will be presented.

Stress can be better understood and treated as the consequence of one's personality which can be transformed through ‘Breakthrough Intimacy’ - closeness between committed couples far greater than their previous maximum experience.

The study collected data of 143 absconding patients, 33% of whom were in confined hospitalization. Most of them were young, single and of low socioeconomic status. Most escaped in the evening shift. There were no significant differences in patient variables between the 2 hospitals. Previous hospitalizations was higher in one of the hospitals (t=2.568, p= .013). There were more staff members in one of the hospitals (t=4.016, p<.0001). There were no difference between the day and the absconding shift.

Childhood adversities are associated with depression as well as increased somatic morbidity.

The Health and Social Support (HeSSup) is a prospective survey of the Finnish working-aged population. Altogether 83 % of the participants of the 1998 survey responded to the second survey five years later (n=19,629). The BDI was used to measure depressiveness and physical illnesses were inquired by asking about physician diagnosed illnesses. Other variables include history of depression, social support, alcohol consumption, negative affectivity, adversities in childhood family, and a checklist of 19 life events.

Among women with childhood adversities the risk of depressiveness was significantly increased after a recent life event (1.81-fold). After adjusting for socio-demographic factors, smoking, alcohol consumption, social support, negative affectivity, baseline cardiovascular morbidity and person dependent life events the risk was still significant (1.48-fold). Among men the respective associations were a bit stronger as risk of depressiveness was 2.11-fold and after adjustments 1.84-fold. Recent life events did not increase risk of cardiovascular disease after recent life events among women and men after adjustments were made. Interestingly, in an analysis by type of recent events violence greatly increased risk of depressiveness and cardiovascular disease among men even after adjustments were made (OR=26.2, 95%CI: 6.99-96.1 and 23.6, 4.61-120.6, respectively) if one had childhood adversities.

Especially experienced violence was associated both to depressiveness and onset of cardiovascular disease. Violence cannot be considered to be fully independent of the person, but according to the adjustments made, impulsiveness probably does not explain the findings.

Stress at work is estimated to be the biggest occupational health problem in the UK. This study assesses work-related stress in a local team of mental health workers.

To identify the work-related stress within multidisciplinary Assertive Outreach Team (AOT).

All sixteen AOT members were given a self-assessment questionnaire. This stress assessment tool consists of six domains and is made up of forty-six questions with a scoring system. Completed questionnaires were filled and anonymously returned back via team secretary.

The overall response rate 80% (n=12). Among six domains of the questionnaire the highly scored item were – “Demands” which in average had a score of 12.3. In this section - “Do you feel that you have much work to do?” was the most scored item with 27 points. At the same section - “Do you feel unable to complete work on time?” and “Do you feel that pressure from work affects your health?” were 2nd and 3rd most scored with 20 points each.

Next significant scores were given for “Control” and “Role” where each scored 9.3. Least points were given for “Relationship” with 4.3 only.

People feel overwhelmed with work demand which affects their ability to work and general health at the same time. It appears that a strategy of efficiency measures can be addressed within the team whilst others need to be taken to higher management level.

Burnout is a state of physical, emotional and mental exhaustion. It affects talented and committed individuals working in demanding working conditions.

Although the risk of the medical community to develop the syndrome is extensively documented, this is the first study that assesses the risk of Burn Out in populations of physicians working in the pharmaceutical industry as managers,researchers or executives.

The survey was performed amongst the 175 members of the Belgian Association of Pharmaceutical Physicians. The primary objective aimed to assess the lifetime prevalence of burnout.

Maslach Burnout Inventory Scale was used to assess gravity of the components of burnout (depersonalization, professional accomplishment, emotional exhaustion).

Eighty members responded. Fifty percent suffered from burnout.

Marital status,solid social network are protecting factors. Stress antecedents aggravate the risk of relapse.

There is a relationship between occurrence of health problems and intensity of emotional exhaustion.

Demography, symptoms profile and the significant factors contributing to the risk are presented.

This snapshot reveals that pharmaceutical physicians continue to be burned out at the same rate as their colleagues clinicians, not aligning on the general employee population.

Given the significant mutual investment from pharmaceutical companies and physicians in each other, prevention should be actively pursued to provide higher job satisfaction as well as better productivity.

The authors believe this findings warrant further study, possibly longitudinally, to uncover possible coping strategies and occurrence of relapse.

Sleep regulation is closely associated to HPA activity. Alterations in both systems may be precursors of psychiatric disorders like depression even at an early stage of development. So far the impact of microstructure in sleep regulation like sleep spindles is unknown. In recent studies, sleep spindles have been linked to efficient cortical-subcortical connectivity and cognitive abilities especially during neurodevelopment.

Sleep spindles in kindergarten children were analyzed and related to sleep regulation and HPA axis functioning.

Patients and Methods: Nine five-year old kindergarten children were enrolled in a cross-sectional examination of HPA system activity assessed by saliva cortisol measurements (morning cortisol after awakening) and sleep regulation investigated by sleep EEG-monitoring. Sleep EEG spindles were visually scored and were put into relation to macrostructural sleep and HPA activity parameters.

Sleep spindles were correlated to basal morning cortisol secretion (AUC basal) (curvilinear r = .83, p = .01), though were negatively correlated to cortisol increase (AUC netto) after awakening (r = -.77, p < .05). Though not statistically significant but by trend, spindle density (i.e. number of spindles per hour of stage 2 -sleep) is negatively correlated to REM density (r = - .57, p = .11), as increase of awakening cortisol was associated to REM density by trend (r = .63, p = .07).

Not only sleep continuation parameters as reported before but also sleep microstructure reflected by sleep spindles may be associated to sleep regulation and HPA system functioning.

The burnout syndrome is a state of physical, emotional and mental exhaustion caused by long term exposure to demanding work situations. It has been suggested that different personal factors, such as gender, age and daily number of patients have influence on the development of this syndrome. The objectives of this study were the following: 1) to assess and compare expressiveness of the dimensions of burnout in psychiatrists; 2) to assess correlation with potential etiological factors (gender, age, number of patients).

The sample consisted of 50 psychiatrists working in health care institutions on the territory of Belgrade. Assessment has been carried out by the Maslach Burnout Inventory and sociodemogafic questionnaire.

The score of the burnout syndrome was different between the three dimensions. i.e. dimension of emotional exhaustion was the most prominent, but moderately increased. Dimension of depersonalization was very low and the lack of personal accomplishment was also moderate but with lower values. We could not find significant correlation with gender, age, nor with number of patients.

Some of potential causative factors associated with the burnout syndrome were investigated. It is important to further explore the correlation between this syndrome and various variables, such personality characteristics, coping strategies and organizational characteristics.

[1] Lecic Tosevski D et al: Burnout syndrome of general practitioners in post war period. Epidemiologia e Psychiatria Sociale, 15 (4): 307-10, 2006.

High rates of occupational burnout syndrome have been found among health service professionals. Our objective was to measure the prevalence of burnout and explore its social demographics and occupational predictors among physicians in Bosnia and Herzegovina.

Answers to the Occupational stress questionnaire (OSQ) were used to assess predictors for burnout and the Maslach burnout inventory were used to categorize respondents into low, moderate and high level of burnout.

534 physicians responded to the survey (76% response rate) and 511 questionnaires could be analyzed. 27.0% of respondents had a high score for emotional exhaustion, 23% had a high score for depersonalization/ cynicism and 23% had a low score for personal accomplishment was found in 29% of physicians. Female physicians were reported more likely than male high level of work related stress and burnout. The predictor of personal accomplishment was only marital status (to be single vs not single; β2=-1, 02, P= 0.01). The main predictors of emotional exhaustion were: work is mentally strenuous and low level of friendly communication at work. High feeling of stress, loss of control over the working ambient and possibility to use knowledge at work were associated with high score of depersonalization.

Intervention program in health care organization to prevent stress at workplace and promotion of staff and patient health should be implemented.

Diabetes melitus has become an epidemic from a global perspective. Diabetes is a classical example of the biopsychosocial model of disease and like most diseases, it has a multifactorial origin. Several lines of evidence support the role of psychosocial distress in promoting the development of diabetes.

To estimate the effect of psychosocial distress on diabetes mortality rate at the aggregate level.

Trends in age-adjusted, sex-specific suicide (as an integral indicator for psychosocial distress) and diabetes mortality rate in Russia from 1956 to 2005 were analyzed employing an ARIMA analysis in order to asses bivariate relationship between the two time series.

Time series analysis indicate the presence of statistically significant association between the two time series for male (r = 0.45; SE = 0.16). The association between the two time series for female also positive, however, statistically not significant (r = 0.25; SE = 0.14).

The results of present study suggest a positive association between male suicide and diabetes mortality rate at the aggregate level and support the hypothesis that psychosocial distress is a risk factor for diabetes at the individual level. This paper presents new epidemiological evidence that supports psychosomatic concept of diabetes melitus.

The Maslach Burnout Inventory, Brief COPE, General Self-Efficacy questionnaire and a job satisfaction scale were filled in by 383 health care workers for opioid addicted patients from Athens, Essen, London, Padua, Stockholm and Zürich. As the study is part of a project examining European drug treatment systems and institutions the individuals´ results were related to organizational features.

One third (29%) of the European staff under survey suffer from severe burnout. Employees from London and Stockholm are significantly more burdened than Zurich personnel where job satisfaction is highest. Males are more prone to burnout. Active strategies to cope with occupational stress were preferred. Some organizational characteristics such as setting and threshold of the treatment program seem to be relevant for the choice of coping strategies and job satisfaction.

In comparison to health care services in other medical fields burnout is a severe problem for drug service workers. The results of the study hint at the necessity to further investigate stress in health care personnel caring for drug addicts and establish effective counteractive measures.

The migratory process can be a considerable source of stress. High levels of acculturative stress would appear to moderate the appearance of mental disorders. Some of the stressors experienced by immigrants are related to homesickness, culture shock, and perceived discrimination, elements not shared with autochthonous individuals. The objective of this study is to analyze the association between acculturative stress and the presence of psychopathology in an immigrant sample in primary care.

Methodology: Cross-sectional study in which a sample of 300 immigrant primary care patients were evaluated with the Barcelona Immigration Stress Scale and the Mini International Neuropsychiatric Interview. The results were analyzed with the statistical package SPSS 15.

Preliminary results indicate that higher levels of acculturative stress are associated with the presence of psychiatric pathology. The most frequent diagnosis is major depressive episode. Acculturative stress varied with demographic factors such as legal status, economic status and length of time in Spain.

Immigrants with higher levels of acculturative stress are more likely to suffer from psychiatric pathology at the time of evaluation with depressive symptomatology occurring most frequently. More research that studies the relationship between acculturative stress and mental health in primary care is needed. In addition, those factors of acculturative stress that best predict psychiatric pathology should be identified.