The aim of this systematic review was to explore studies regarding association between occupational stress and heart rate variability (HRV) during work. We searched PubMed, Web of Science, Scopus, Cinahl and PsycINFO for peer-reviewed articles published in English between January 2005 and September 2017. A total of 10 articles met the inclusion criteria. The included articles were analyzed in terms of study design, study population, assessment of occupational stress and HRV, and the study limitations. Among the studies there were cross-sectional (n=9) studies and one longitudinal study design. Sample size varied from 19 to 653 participants and both females and males were included. The most common assessment methods of occupational stress were the Job Content Questionnaire (JCQ) and the Effort-Reward Imbalance (ERI) questionnaire. HRV was assessed using 24 h or longer Holter ECG or HR monitoring and analyzed mostly using standard time-domain and frequency-domain parameters. The main finding was that heightened occupational stress was found associated with lowered HRV, specifically with reduced parasympathetic activation. Reduced parasympathetic activation was seen as decreases in RMSSD and HF power, and increase in LF/HF ratio. The assessment and analysis methods of occupational stress and HRV were diverse.

The patients with a normal mood and those who recovered from depressive symptoms enjoyed the most favorable outcome. Depressive symptoms interfere strongly with the ability of patients to obtain an optimal surgery outcome. Treatment models including the assessment and treatment of depression are encouraged.

The objective of this observational prospective study was to investigate the effect of depression on shortterm outcome after lumbar spinal stenosis (LSS) surgery. Surgery was performed on 99 patients with clinically and radiologically defined LSS, representing ordinary LSS patients treated at the secondary care level. They completed questionnaires before surgery and 3 months postoperatively. Depression was assessed with the 21-item Beck Depression Inventory (BDI). Physical functioning and pain were assessed with Oswestry disability index, Stucki Questionnaire, self-reported walking ability, visual analogue scale (VAS) and pain drawing. Preoperatively, 20% of the patients had depression. In logistic regression analyses, significant associations were seen between preoperative depression and postoperative high Oswestry disability and Stucki severity scores and high intensity of pain (VAS score). In subsequent analyses, the patients with continuous depression, measured with BDI (60% of the patients who had preoperative depression), showed fewer improvements in symptom severity, disability score, pain intensity and walking capacity than the patients who did not experience depression at any phase. In those patients who recovered from depression, according to BDI-scores (35% of the patients with preoperative depression), the postoperative improvement was rather similar to the improvement seen in the normal mood group. In the surgical treatment of LSS, we recommend that the clinical practice should include an assessment of depression.

Current Controlled Trials ISRCTN64794760.