Mittuniversitetet

På många arbetsplatser sker idag olika typer av friskvårdssatsningar i syfte att få friskare medarbetare med hög arbetskapacitet och som är motiverade i sitt arbete. Studiens primära syfte var att undersöka om utnyttjandegraden av friskvårdsförmånerna har en positiv effekt på den upplevda arbetsmotivationen. Författarna ämnade även att sekundärt kartlägga inledningarna till varför de anställda inte utnyttjar friskvårdsförmånerna fullt ut. En enkätstudie genomfördes på en avdelning hos Försäkringskassan i Östersund. Totalt deltog 109 respondenter. Data analyserades med hjälp av korrelationer, t-test, regressionsanalys samt variansanalys. Resultaten visar attutnyttjandegraden av friskvårdsförmåner inte har någon märkbar effekt på den upplevda arbetsmotivationen. De anställda utnyttjar friskvårdsförmånerna i relativt stor utsträckning och den upplevda arbetsmotivationen är förhållandevis hög. Friskvårdsförmånerna bedöms vara en väsentlig del av arbetsförhållandet och kan i enlighet med Herzbergs motivationsteori ses som en hygienfaktor.

Konsumentverket har enligt skuldsaneringslagen (SFS 2006:548) uppdrag att stödja och vägleda den budget- och skuldrådgivning som kommunerna skall svara för. Detta innefattar bland annat utbildning, metodutveckling, kunskapsbyggande och information samt utvärdering. Som ett led i detta har verket initierat en utvärdering av verksamheten från, såväl ett gäldenärsperspektiv som ur ett samhällsekonomiskt perspektiv. Föreliggande rapport är en del av en kommande större rapport rörande bl.a. ekonomi och hälsoaspekter i samband med överskuldsättning och skuldrådgivning i kommunerna. Författare är docent Richard Ahlstöm och forskningsassistent Mattias Savemark. De slutsatser och ståndpunkter som redovisas här är författarnas egna och de ansvarar för delrapportens riktighet och innehåll.

Identifying brain systems that regulate or modulate autonomic nervous system functions may identify pathways through which psychosocial factors can influence health and disease. Reduced high-frequency heart rate variability (HF-HRV) characterizes anxiety disordered patients and is predictive of adverse myocardial events. Sex differences in the prevalence of anxiety disorders and cardiac diseases implicate the possibility of sex specific neural regulation of HF-HRV. We investigated the correlation between HF-HRV and regional cerebral blood flow (rCBF) in 28 subjects (15 women) with social phobia undergoing a stressful public speaking task. Regional CBF was measured with [(15)O] water positron emission tomography. Stress induced rCBF correlated positively with HF-HRV in the right supra genual anterior cingulate cortex Brodmann's area (BA) 32, the right head of the caudate nucleus and bilaterally in the medial prefrontal cortex (BA10), extending into the dorsolateral prefrontal cortex (BA46) in the left hemisphere. Men showed larger positive co-variation in the caudate than women. These findings underscore the importance of the emotional division of the anterior cingulate cortex, the prefrontal cortex and the striatum in cardiovagal activity. The study replicates and extends results from published functional neuroimaging studies on cardioregulatory or modulatory areas in healthy subjects to men and women with social phobia. Moreover, caudate functions, possibly related to dopaminergic neurotransmission, have sexually dimorphic effects on vagal modulation of the heart.

In the ongoing debate in the area of critical leadership studies, the nature of leader–follower relationships is a thorny issue. The nature of followership has been questioned, especially whether followers can display resistance behaviours while maintaining their follower position. Addressing this issue requires a dialectical approach in which followers and leaders alike are primary elements in leadership co-production. Followers who face destructive leaders are of special interest when leadership is studied as a co-creational process. This context favours the emergence of a full range of behavioural profiles in which passives and colluders will illustrate the destructive leadership co-production process, and those who resist demonstrate that followers may not follow the leader and still keep a followership purpose. A two-step data analysis procedure was conducted based on the behaviour descriptions of 123 followers having a destructive leader. A qualitative analysis (i.e. content analysis) showed a set of behaviours and their antecedents that suggest three main groups of followers: resisters, obedient and mixed behaviour. Treating these data quantitatively (i.e. latent class analysis), six followers’ profiles emerged: active resistance, passive resistance, passive obedience, conflict avoidance, support and mixed. Our findings provide evidence that followers who resist may do it for the sake of the organisation. We discuss our findings in light of followership theory, whereby joining role-based and constructionist approaches allows us to argue that followers may still be followers even when they do not invariably follow their leader. 

Burnout is common in many countries and is associated with several other problems such as depression, anxiety, insomnia, and memory deficits, and prospectively it predicts long-term sick-leave, cardiovascular disease, and death. Clinical burnout or its residual symptoms often last several years and a common assumption is that recovery takes a long time by nature, despite full time sick-leave and the absence of work stress. The literature suggests models that hypothetically explain the development, but not maintenance, of the syndrome. Based on cognitive and behavioral principles, stress research, and stress theories, this paper describes a theoretical model explaining how clinical burnout can develop and be maintained. While the development of clinical burnout is mainly explained by prolonged stress reactions and disturbed recovery processes due to work related stressors, maintenance of the syndrome is particularly explained by prolonged stress reactions and disturbed recovery processes due to the new context of experiencing burnout and being on sick-leave. Worry about acquired memory deficits, passivity and excessive sleep, shame, fear of stress reactions, and the perception of not being safe are examples of responses that can contribute to the maintenance. The model has important implications for research and how to intervene in clinical burnout. For example, it can offer support to professional care providers and patients in terms of focusing on, identifying, and changing current contextual factors and behaviors that maintain the individual’s clinical burnout symptoms and by that facilitate burnout recovery. Regarding research, the model provides a highly important reason for researchers to study contextual factors and behaviors that contribute to the maintenance of clinical burnout, which has been neglected in research.

The recovery perspective on stress management is new and few recovery intervention studies have been conducted. The aim of the study was to evaluate behavioral effects of a functionalistic stress recovery intervention, in which individuals perceiving high levels of stress were encouraged to pay attention to possibilities to perform potential recovery behaviors in everyday life and to choose behaviors that were predicted to lead to resource restoration. Seventy-three individuals were randomly allocated to either a 10-week intervention or a waiting-list control group. Three types of recovery behavior factors during leisure time were studied: perceived recovery opportunities (i.e., control), relaxational behaviors (i.e., relaxation), and positively challenging behaviors (i.e., mastery). In comparison with the control group, the intervention group significantly improved, showing high between-group effect sizes, regarding perceived recovery opportunities (p < 0.001; d = 0.75) and relaxational behaviors (p < 0.001; d = 0.80). Both groups normalized their levels of positively challenging behaviors between pre- and postassessment, and no statistically significant group difference was demonstrated. Analyses of reliable and clinically significant changes demonstrated results in favor of the intervention group regarding perceived recovery opportunities and relaxational behaviors but not positively challenging behaviors. The tested intervention warrants further research, for example, if a modified version of the intervention including components aiming at increasing postwork positively challenging behaviors would be beneficial for the improvement of the behavior and for health. 

Background. High levels of perceived stress and stress-related ill health, such as burnout, are common in many countries. Several theories postulate that stress behaviors promote adaption to environmental changes and if sustained they are potentially harmful for the body. In accordance, impaired stress recovery behaviors, i.e., psychophysiological deactivation after periods of stress behaviors, have been suggested to be a critical factor in explaining stress-related ill health. Whereas research shows that interventions targeting stress reactivity can have beneficial effects on stress-related variables, studies on interventions targeting stress recovery are surprisingly few. Also, the number of validated instruments for measuring behaviors important for stress recovery are few, in particular easily used self-rating scales. 

Aims. The primary aim of the thesis was to evaluate stress and health-related effects of an intervention targeting stress recovery behaviors in everyday life among people perceiving high levels of stress in life. A secondary aim was to validate a self-report scale measuring behaviors important for stress recovery in everyday life. 

Method. Three empirical studies were conducted to evaluate effects of the behavioral stress recovery intervention “balance in everyday life”, which solely aims at strengthening stress recovery behaviors in everyday life. First, a brief version of the intervention was investigated through a small pilot study in which a single-subject experimental design was used (study 1). After that, the intervention was exploratively tested in a group format in which a quasi-experimental design was used (study 2). Due to the positive results of these two studies, a larger scale study using a randomized controlled design was conducted in order to further investigate the effects of the intervention when delivered in a group format (study 3). To fulfill the secondary aim of the thesis, the Recovery Experience Questionnaire was translated into Swedish and analyzed using exploratory factor analysis and confirmatory factor analysis (study 4). 

Results. In study 1, data demonstrated immediate reduction of stress symptoms as a function of the intervention. The improvements were maintained at 1-year and 5-year follow-up assessments. In study 2, in comparison with a waiting-list-control group, the intervention yielded statistically significant improvements between pre- and postintervention assessment on eleven out of twelve stress and health-related variables. Medium to large between-groups effect sizes were demonstrated for the primary outcome measures covering (potential) recovery behaviors, perceived stress and rest and experiences of being recovered. In the third study, statistically significant improvements for all outcome measures at postintervention assessment and at the 3-month follow-up were demonstrated. The between-groups effect sizes for the primary measures - perceived stress, tension, and burnout - were medium-to-high at postintervention assessment and at follow-up. In addition, in all studies the intervention was associated with beneficial changes in levels of anxiety and depression. In the last study, support was found for the proposed four-factor structure of the Swedish version of the Recovery Experience Questionnaire. 

Conclusions. The results clearly indicate that the intervention “balance in everyday life” improves stress and health-related factors in a relatively satisfactory way among people perceiving high levels of stress in life. The empirical support is strongest for the reduction in tension, perceived stress, burnout, anxiety and depression, and to deliver the intervention in a group format. The studies demonstrated results that warrant further investigation of the effects of “balance in everyday life”, for example in different contexts, and to study other behavioral recovery interventions. To test (potential) recovery facilitating behaviors as mediators of intervention effects, such as reduction in burnout, the Swedish version of the Recovery Experience Questionnaire could be used.

Förmodligen ser återhämtningsbehovet ut ungefär som kostbehovet. Vi mår bäst av att äta då och då – några gånger per dag – snarare än att äta jättemycket en gång om dagen, eller bara på helgen … eller semestern.

Stresshantering har tidigare mest handlat om att minska faktorer som leder till stress. Men många forskare är idag överens om att det inte är stressen i sig som orsakar ohälsa – utan bristen på återhämtning.

Psykologen och forskaren Niclas Almén ger in sin bok många infallsvinklar på återhämtning. Han beskriver också ett program som stegvis och strukturerat vägleder dig i att förbättra din återhämtning i vardagen.

Programmet leder till ökad både mental och fysisk pigghet, samtidigt som det minskar upplevd stress, irritabilitet, jäkt, oro, ångest, nedstämdhet och utmattning. Ditt välbefinnande har med andra ord goda chanser att öka om du följer råden! 

Boken riktar sig till dig som vill må bra, leva ett aktivt liv och prestera så bra som möjligt utan att behöva göra det omöjliga: ta bort all stress – vare sig om det är i förebyggande syfte eller om du har utvecklat utmattningsproblem.

Burnout is a common problem in many countries and is associated with psychological ill health, somatic diseases, mortality and long-term sick leave. Different versions of the Shirom-Melamed Burnout Questionnaire/Measure (SMBQ/SMBM) are widely used to measure burnout. Using confirmatory factor analysis, the main purpose of the present study was to empirically evaluate different Swedish versions of the SMBQ/SMBM. A questionnaire containing 23 SMBQ/SMBM-items was sent to 4,000 randomly selected individuals of which 765 with no missing data were included in the analyses. The well-used 4-factor SMBQ/SMBM-22 including the factors emotional and physiological exhaustion (EPE), cognitive weariness (CWE), listlessness (LIS), and tension (TES) and the 3-factor SMBQ/SMBM-18 (including the EPE, the CWE, and the LIS) reached good model fit after minor modifications. Two 2-factor models (based on 12 and 11 items, respectively), including the EPE and the CWE reached good model fit without any modifications. Even though there were some concerns regarding all models with respect to discriminant validity, the factors in all models showed evidence of good composite reliability (CR) and convergent validity. Lastly, a brief six-item version of the scale based on the 12-item version of the scale indicated an excellent model fit, and the composite score of the six-item scale correlated strongly with the composite scores from the others models, suggesting that the brief version could be used with advantage. In addition, based on the LIS, a new three-item scale that measures vitality is proposed. For all measures, normative data are reported.

The Shirom-Melamed Burnout Questionnaire/Measure (SMBQ/M) is one of the most commonly used measures of burnout. Using confirmatory factor analyses, the present study aimed to evaluate the model fit, composite reliability, and fac-torial (i.e. convergent and discriminant) validity of the new brief Swedish version of the scale-labeled SMBM-6. In addition, we used Cronbach’s α as an indicator of the internal consistency of the total scale. The SMBM-6 consists of two subscales: the emotional and physiological exhaustion subscale (three items) and the cognitive weariness subscale (three items). A total of 1251 teachers in Sweden were included in the study. The analyses showed that the Swedish version of the SMBM-6 has an excellent model fit and good convergent validity. The discriminant validity for the cognitive weariness subscale was good, but slightly inadequate for the physiological exhaustion subscale. Composite reliability and Cronbach’s α indicated high internal consistency for the subscales and the total scale, respectively. Multi-group invar-iance tests for age indicated no violation of invariance. These results are consistent with those of the study by Almén and Jansson (2021), in which the SMBM-6 was developed, and a subsequent psychometric study by Sundström et al. (2022). In conclusion, there is strong support for the Swedish version of the SMBM-6 as a reliable and valid scale for measuring burnout. Testing the scale in languages other than Swedish is warranted.

Background: Research has shown that younger patients who have had a myocardial infarction (MI) experience more emotional distress than their older counterparts.

Objective: In this study, we aimed to compare emotional distress 2 months post-MI (follow-up 1) between younger (<55) vs older (≥55) patients in Sweden, and investigate its impact on working status and 4 secondary preventive goals 1 year after MI (follow-up 2).

Methods: Data (N = 50 213) from the SWEDEHEART National Quality Registers for Cardiac Care, which covers approximately 90% of all MIs in Sweden, were used.

Results: After adjusting for confounders, logistic regression analyses showed that younger patients who had experienced an MI had higher odds of experiencing emotional distress than older patients at follow-up 1 (adjusted odds ratio [AOR], 1.59; 95% confidence interval [CI], 1.52–1.67) and follow-up 2 (AOR, 1.47; 95% CI, 1.40–1.55). Emotional distress at follow-up 1 was associated with lower odds of working (AOR, 0.60; 95% CI, 0.53–0.67) and achieving smoking and physical activity goals (AOR, 0.76; 95% CI, 0.67–0.86; AOR, 0.83; 95% CI, 0.76–0.91) at follow-up 2. However, emotional distress was not associated with achieving goals for low-density lipoproteins or systolic blood pressure at follow-up 2.

Conclusions: Younger patients experienced emotional distress more often after a first-time MI than their older counterparts, and their distress predicted long-term lower levels of returning to work and achievement of smoking and physical activity goals. The results highlight the importance of identifying younger patients who have had an MI and are experiencing emotional distress, and offering them interventions targeting distress.

Abstract

INTRODUCTION

Stress symptoms, burnout, poor mental health and long-term sick leave related to these are major problems in Sweden and elsewhere. Evidence-based prevention and treatment efforts are lacking. Research indicates that stress related health problems primarily could be conceptualized as deficiencies in recovery responses between stress periods rather than high level of stress responses per se. Therefore it is relevant to examine whether it is effective to intervene the recovery behavior – instead of the stress behavior - of people with stress symptoms.

OBJECTIVES

The primary purpose of this study was to investigate if a behavioral oriented recovery management intervention could enhance “recovery behaviors” and experiences of recovery and reduce stress related ill health.

METHODS A group based intervention program focusing exclusively on “recovery behavior” in everyday life (earlier developed and tested in two pilot studies) was evaluated in an experimental group study. The intervention consisted of seven group sessions of 2.5 hours over a period of approximately 10 weeks supplemented by an internet based treatment support system. Self- referred subjects with scores above 24.4 on the Perceived stress scale were randomized to the intervention (n=26) or a waiting-list (n=33).

RESUL T

Statistically significant and clinically relevant effects were achieved for the intervention group compare to the waiting-list group: recovery behaviors and experiences of recovery were increased, and levels of perceived stress, worry, anxiety, depression and exhaustion were decreased.

DISCUSSION These results are in line with two previous pilot studies that we have done. A behavioral and recovery oriented intervention seems to be effective to increase the recovery of the individual and decrease stress related ill health. There are reasons to continue to explore the potential of recovery-oriented interventions for example for different populations (such as people with more extensive clinical health problems) and in different contexts. 

Work-related stress is considered one of the biggest health and safety challenges among the member states of the European Union. A critical factor is recovery between periods of stress. The primary purpose of this study was to investigate whether a brief behaviorally oriented stress-recovery management intervention delivered in an individual setting could reduce stress symptoms among individuals with high levels of perceived stress. A single-subject experimental design with multiple baselines across three individuals was used. The results indicate, with at least moderate experimental control, a temporal relation between the start of the intervention and beneficial changes from baseline in continuous self-recordings of stress symptoms. The changes were maintained at 1-year and 5-year follow-up assessments. Also, self-reporting inventories measuring perceived stress, worry, anxiety, depression, burnout, type A behavior, unwinding and recuperation from work stress, and insomnia showed overall changes in beneficial directions at post-assessment, as well as the two follow-up assessments. The results indicate that a behaviorally oriented stress-recovery management intervention delivered in an individual setting can reduce stress symptoms in individuals with high levels of perceived stress. However, for firm conclusions to be drawn, further research is needed. 

Continuous and prolonged exposure to stressors or unsuccessfully dealing with such exposure has been suggested as precursors for burnout. Current research indicates that such stress problems could be conceptualized as deficiencies in recovery between periods of stress. The purpose of this study was to evaluate the efficacy of a behaviorally oriented stress recovery management intervention for people experiencing high levels of stress. A total of 73 individuals with experiences of stress symptoms and high levels of perceived stress (≥ 25 on the Perceived Stress Scale) were randomly allocated to either a 10-week intervention group or a waiting-list control group. Participants were assessed at preintervention, postintervention, and 3-month follow-up. The Perceived Stress Scale, questions about tension, and the Shirom–Melamed Burnout Questionnaire were used as primary outcome measures, and the Hospital Anxiety and Depression Scale was used as a secondary outcome measure. Data were analyzed following the intention-to-treat principle. The analysis demonstrated statistically significant improvements for all measures at posttreatment and at follow-up. The between-groups effect sizes were high at posttreatment and moderate–to-high at follow-up. Intervention focused on stress recovery behavior seems to be an effective way of reducing perceived stress, tension, burnout symptoms, anxiety, and depression in people with stress symptoms and high levels of perceived stress in everyday life. The tested intervention warrants further research. Other stress recovery behavior interventions need to be tested to draw conclusions on the efficacy of stress recovery behavior interventions in general regarding stress and burnout.

Recent research has indicated that recovery from work stress and effort might be crucial for health and well-being. Thus, a valid measurement of recovery becomes important. The main purpose of the present study was to empirically evaluate and seeking support for the hypothesized four-factor model of the Swedish version of Recovery Experience Questionnaire (REQ). The total sample (N = 680) was randomly split into two subsamples. The first subsample was used for finding the best-fitting model using an exploratory factor analysis and the second subsample was used to test the a priori model using confirmatory factor analysis. The results support the proposed four-factor structure of the scale for both males and females. Additionally, apart from high reliability estimates, this instrument proved to have good convergent and discriminant validity for all four factors. Implications for the use of the REQ in conjunction with recovery-focused interventions were discussed, as were limitations such as low response rate. 

Background: Continuous and prolonged exposure to stressors or unsuccessfully dealing with such exposure has been suggested as precursors for burnout. Current research indicates that such stress problems could be conceptualized as deficiencies in recovery between periods of stress. The purpose of this study was to evaluate the efficacy of a brief stress-recovery behavior intervention for people experiencing high levels of stress. Method: Seventy-three individuals with experiences of stress symptoms and high levels of perceived stress (≥ 25 on the Perceived Stress Scale) were randomly allocated to either a 12-week intervention group (INT) or a waiting list control group (WLC). Participants were assessed at pre-intervention, post-intervention and at 3-month follow-up. Data, including indices of Heart Rate Variability (HRV), Perceived stress scale (PSS), questions about tension, Shirom-Melamed Burnout Questionnaire (SMBQ), and the Hospital Anxiety and Depression Scale (HADS) as a secondary outcome measure, will be analyzed and presented following the intention-to-treat principle.

Background:  Stress problems could be conceptualized as deficiencies in recovery between periods of stress and research indicates that recovery from work stress and effort might be crucial for health and well-being. The purpose of this study was to evaluate the efficacy of a behaviorally oriented stress-recovery management intervention for people with high levels of perceived stress on different recovery experiences.

Method: 73 individuals with high levels of perceived stress (>24.4 on Perceived Stress Scale) were randomly allocated to either a 10-week intervention group or a waiting list control group. Participants were assessed at pre-intervention, immediately after the intervention, and 3-month after the end of the intervention. The outcome measures were the four dimensions of the Recovery Experiences Questionnaire (REQ): relaxation, mastery, control and psychological detachment. For analysis the intention-to-treat principle was used.

Results: Preliminary analysis indicated positive results on measurements of different recovery dimensions of this brief intervention.

Teachers are particularly affected by stress and burnout. Recovery experiences are crucial to counteract the harmful continuation of everyday life stress reactions. There is a lack of knowledge regarding recovery experiences and its importance for burnout among compulsory school teachers. The aim of the present study was to investigate (1) the levels of burnout and different recovery experiences during leisure time among female compulsory school teachers in Sweden, and (2) to which extent different recovery experiences explain burnout. In a non-random sample of female compulsory school teachers (n = 570) and a random sample from a general female working population (n = 457/393), the participants self-rated their levels of burnout and their recovery experiences during leisure time via the brief version of the Shirom-Melamed Burnout Measure and the Recovery Experience Questionnaire, respectively. Independent t-tests showed that, compared to the general female working population, the female compulsory school teachers scored (1) significantly higher on burnout (with a high magnitude of effect, d = 0.87), and (2) significantly lower on recovery experiences (d = 0.38–1.23). In total, recovery experiences explained 37% of the variance in burnout. Among the four recovery experiences being investigated, Psychological detachment explained the highest variance in burnout (27%), with Mastery and Control also being significant predictors in the model. Surprisingly, the variance of Relaxation in explaining burnout was close to zero. The study suggests enhancing the circumstances that foster psychological detachment among female compulsory school teachers in Sweden and further investigation of recovery experiences among teachers.

OBJECTIVE: To examine the impact of a Cognitive Behavior Therapy (CBT)-based intervention on HbA(1c), self-care behaviors and psychosocial factors among poorly controlled adult type 1 diabetes patients. METHODS: Ninety-four type 1 diabetes patients were randomly assigned to either an intervention group or a control group. The intervention was based on CBT and was mainly delivered in group format, but individual sessions were also included. All subjects were provided with a continuous glucose monitoring system (CGMS) during two 3-day periods. HbA(1c), self-care behaviors and psychosocial factors were measured up to 48 weeks. RESULTS: Significant differences were observed with respect to HbA(1c) (P<0.05), well-being (P<0.05), diabetes-related distress (P<0.01), frequency of blood glucose testing (P<0.05), avoidance of hypoglycemia (P<0.01), perceived stress (P<0.05), anxiety (P<0.05) and depression (P<0.05), all of which showed greater improvement in the intervention group compared with the control group. A significant difference (P<0.05) was registered with respect to non-severe hypoglycemia, which yielded a higher score in the intervention group. CONCLUSION: This CBT-based intervention appears to be a promising approach to diabetes self-management. PRACTICE IMPLICATIONS: Diabetes care may benefit from applying tools commonly used in CBT. For further scientific evaluation in clinical practice, there is a need for specially educated diabetes care teams, trained in the current approach, as well as cooperation between diabetes care teams and psychologists trained in CBT.

Aim To describe experience from a behavioural medicine intervention among poorly controlled adult type 1 diabetes patients, in terms of feasibility, predictors and associations of improved glycaemic control. Methods Data were collected on 94 poorly controlled adult type 1 diabetes patients who were randomised to a study evaluating the effects of a behavioural medicine intervention. Statistics covered descriptive and comparison analysis. Backward stepwise regression models were used for predictive and agreement analyses involving socio-demographic and medical factors, as well as measures of diabetes self-efficacy (DES), diabetes locus of control (DLOC), self-care activities (SDSCA), diabetes-related distress (Swe-PAID-20), fear of hypoglycaemia (HFS), well-being (WBQ), depression (HAD) and perceived stress (PSS). Results The participation rate in the study was 41% and attrition was 24%. Of those patients actually participating in the behavioural medicine intervention, 13% withdrew. From the regression models no predictors or associations of improvement in HbA1c were found. Conclusions The programme proved to be feasible in terms of design and methods. However, no clear pattern was found regarding predictors or associations of improved metabolic control as the response to the intervention. Further research in this area is called for.

Aims The aim of this studywas toexamine the fearof hypoglycaemiaand its association with demographic anddisease-specificvariables in a large and unselective population of adult patients with Type 1 diabetes.

Methods Questionnaires were sent by post to all patients with Type 1 diabetes who were identified in the local diabetesregistries of two hospitals in Stockholm, Sweden (n = 1387). Fear of hypoglycaemia was measured using the SwedishHypoglycaemia Fear Survey, theWorry subscale and theAloneness subscale.Demographic variables and disease-specific factorswere collected from patients’ self reports and medical records. Univariate analysis and multiple stepwise linear regressionanalysis were used in the statistical analyses of the data.

Results Seven hundred and sixty-four (55%) patients participated in the study (mean age 43.3 years andmeanHbA1c 7.0%,normal < 5.0%). The Hypoglycaemia Fear Survey - Worry subscale was significantly associated with frequency of severehypoglycaemia, number of symptoms during mild hypoglycaemia, gender, hypoglycaemic symptoms during hyperglycaemiaand hypoglycaemic unawareness. The Hypoglycaemia Fear Survey - Aloneness subscale was significantly associated withfrequency of severe hypoglycaemia, number of symptoms during mild hypoglycaemia, gender, frequency of mildhypoglycaemia, HbA1c, hypoglycaemic unawareness and visits to the emergency room because of severe hypoglycaemia. Fear of hypoglycaemia proved to be more prevalent in females and indicated a different pattern between genders in relation tofactors associated with fear of hypoglycaemia.

Conclusions This study identifies the frequency of severe hypoglycaemia as themost important factor associated with fear ofhypoglycaemia. Moreover, for the first time,we document gender differences in fear of hypoglycaemia, suggesting that femalesare more affected by fear of hypoglycaemia than men.