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BMC Primary Care
Published in: BMC Primary Care 1/2020

Open Access 01-12-2020 | Care | Research article

Effects of a work stress intervention on healthcare use and treatment compared to treatment as usual: a randomised controlled trial in Swedish primary healthcare

Authors: Christine Sandheimer, Tove Hedenrud, Gunnel Hensing, Kristina Holmgren

Published in: BMC Primary Care | Issue 1/2020

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Abstract

Background

Work stress is an increasing burden in society. Identifying early symptoms of work stress in primary healthcare (PHC) could result in earlier and better-targeted care. The Work Stress Questionnaire (WSQ) was developed in PHC for this task. We aimed to evaluate whether the use of the WSQ, in combination with physicians’ feedback, resulted in differences in healthcare visits and treatment compared to treatment as usual (TAU) in patients reporting high stress. Our hypothesis was that patients receiving the intervention would generate more visits to rehabilitation providers during follow-up compared to TAU.

Methods

A two-armed randomised controlled trial was conducted at seven primary healthcare centres (PHCCs) in Region Västra Götaland, Sweden. One group received the WSQ intervention, and the controls received TAU. Employed, not sick-listed persons aged 18–64 years who sought care for mental or physical health complaints at the PHCCs participated. Register data on healthcare visits and treatments 12 months prior to inclusion and 12 months after were obtained and analysed with Fisher’s exact test together with questionnaire data (WSQ and background features).

Results

A total of 271 participants were included in the study, 132 intervention and 139 controls. Visits to psychologists/psychotherapists were higher among intervention participants with high stress (20%, n = 87) during follow-up compared to corresponding controls (7%, n = 97) (p < 0.05). Collaborative care measures were more common among the stressed intervention participants (23%) post-inclusion compared to the stressed controls (11%) (p < 0.05). The amount of received cognitive behavioural therapy (CBT) was higher among the stressed intervention group (16%) than among controls (10%) during follow-up.

Conclusions

The intervention group that used the WSQ with physicians’ feedback had an increased number of rehabilitative measures and treatment more in line with established guidelines compared to treatment as usual. Findings of the study indicate that the WSQ can assist in identifying work stress in primary healthcare and contribute to physicians’ recommendations of suitable rehabilitative measures at an earlier stage compared to treatment as usual.

Trial registration

ClinicalTrials.gov. Identifier: NCT02480855. Registered 20 May 2015.
Appendix
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Literature
1.
World Health Organization. Depression and other common mental disorders: Global Health estimates. Geneva: World Health Organization; 2017.
2.
Organisation for Economic Co-operation and Development, Union E: Health at a Glance: Europe 2018. 2018.
3.
Henderson M, Harvey SB, Overland S, Mykletun A, Hotopf M. Work and common psychiatric disorders. J R Soc Med. 2011;104:198–207.CrossRef
4.
Organisation for Economic Co-operation and Development. Mental health and work: Sweden. Paris: OECD; 2013.
5.
Miranda V. Organisation for economic co-operation and development: sick on the job?: myths and realities about mental health and work. Paris: OECD Publishing; 2012.
6.
Swedish National Board of Health and Welfare. Exhaustion disorder: stress-related mental ill health [In Swedish: Utmattningssyndrom: Stressrelaterad psykisk ohälsa]. Stockholm: Socialstyrelsen; 2003.
7.
European Commission. Flash Eurobarometer 398 ‘Working Conditions’. TNS Political & Social at the request of the European Commission D-GE, Social Affairs and Inclusion ed.; 2014.
8.
Levi L, Bartley M, Marmot M, Karasek R, Theorell T, Siegrist J, Peter R, Belkic K, Savic C, Schnall P, Landsbergis P. Stressors at the workplace: theoretical models. Occup Med. 2000;15:69–106.PubMed
9.
Siegrist J. Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol. 1996;1:27–41.CrossRef
10.
Eurofund and EU-OSHA. Psychosocial risks in Europe: Prevalence and strategies for prevention. Luxembourg: Publications Office of the European Union; 2014.
11.
Mather L, Bergstrom G, Blom V, Svedberg P. High job demands, job strain, and Iso-strain are risk factors for sick leave due to mental disorders: a prospective Swedish twin study with a 5-year follow-up. J Occup Environ Med. 2015;57:858–65.CrossRef
12.
Vingård E. Common Mental Disorders, working life and sickness absence. A knowledge review. [In Swedish: Psykisk ohälsa, arbetsliv och sjukfrånvaro. En kunskapsöversikt]. Stockholm: FORTE: Forskningsrådet för hälsa, arbetsliv och välfärd; 2015.
13.
Roca M, Gili M, Garcia-Garcia M, Salva J, Vives M, Garcia Campayo J, Comas A. Prevalence and comorbidity of common mental disorders in primary care. J Affect Disord. 2009;119:52–8.CrossRef
14.
Sundquist J, Ohlsson H, Sundquist K, Kendler KS. Common adult psychiatric disorders in Swedish primary care where most mental health patients are treated. BMC Psychiatry. 2017;17:235.CrossRef
15.
Lykkegaard J, Rosendal M, Brask K, Brandt L, Prior A. Prevalence of persons contacting general practice for psychological stress in Denmark. Scand J Prim Health Care. 2018;36:272–80.CrossRef
16.
Wiegner L, Hange D, Bjorkelund C, Ahlborg G Jr. Prevalence of perceived stress and associations to symptoms of exhaustion, depression and anxiety in a working age population seeking primary care--an observational study. BMC Fam Pract. 2015;16:38.CrossRef
17.
Adamsson A, Bernhardsson S. Symptoms that may be stress-related and lead to exhaustion disorder: a retrospective medical chart review in Swedish primary care. BMC Fam Pract. 2018;19:172.CrossRef
18.
SBU. Case finding, diagnosis and follow-up of patients with affective disorders [In Swedish: Diagnostik och uppföljning av förstämningssyndrom. En systematisk litteraturöversikt]. Stockholm: Swedish Agency for Health Technology Assessment and Assessment of Social Services; 2012.
19.
Holmgren K, Hensing G, Dahlin-Ivanoff S. Development of a questionnaire assessing work-related stress in women - identifying individuals who risk being put on sick leave. Disabil Rehabil. 2009;31:284–92.CrossRef
20.
Holmgren K, Dahlin Ivanoff S. Women on sickness absence--views of possibilities and obstacles for returning to work. A focus group study. Disabil Rehabil. 2004;26:213–22.CrossRef
21.
Holmgren K, Fjallstrom-Lundgren M, Hensing G. Early identification of work-related stress predicted sickness absence in employed women with musculoskeletal or mental disorders: a prospective, longitudinal study in a primary health care setting. Disabil Rehabil. 2013;35:418–26.CrossRef
22.
Holmgren K, Sandheimer C, Mardby AC, Larsson ME, Bultmann U, Hange D, Hensing G. Early identification in primary health care of people at risk for sick leave due to work-related stress - study protocol of a randomized controlled trial (RCT). BMC Public Health. 2016;16:1193.CrossRef
23.
24.
Schulz KF, Altman DG, Moher D, Group C. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. PLoS Med. 2010;7:e1000251.CrossRef
25.
Bultmann U, Huibers MJ, van Amelsvoort LP, Kant I, Kasl SV, Swaen GM. Psychological distress, fatigue and long-term sickness absence: prospective results from the Maastricht cohort study. J Occup Environ Med. 2005;47:941–7.CrossRef
26.
Stansfeld SA, Shipley MJ, Head J, Fuhrer R, Kivimaki M. Work characteristics and personal social support as determinants of subjective well-being. PLoS One. 2013;8:e81115.CrossRef
27.
Burton C. Beyond somatisation: a review of the understanding and treatment of medically unexplained physical symptoms (MUPS). Br J Gen Pract. 2003;53:231–9.PubMedPubMedCentral
28.
Reid S, Wessely S, Crayford T, Hotopf M. Medically unexplained symptoms in frequent attenders of secondary health care: retrospective cohort study. BMJ. 2001;322:767.CrossRef
29.
Toft T, Fink P, Oernboel E, Christensen K, Frostholm L, Olesen F. Mental disorders in primary care: prevalence and co-morbidity among disorders. Results from the functional illness in primary care (FIP) study. Psychol Med. 2005;35:1175–84.CrossRef
30.
Holmgren K, Dahlin-Ivanoff S, Bjorkelund C, Hensing G. The prevalence of work-related stress, and its association with self-perceived health and sick-leave, in a population of employed Swedish women. BMC Public Health. 2009;9:73.CrossRef
31.
Frantz A, Holmgren K. The work stress questionnaire (WSQ) - reliability and face validity among male workers. BMC Public Health. 2019;19:1580.CrossRef
32.
Swedish National Board of Health and Welfare. National guidelines for care of depression and anxiety disorders [In Swedish: Vård vid depression och ångestsyndrom]. Stockholm: Socialstyrelsen; 2017.
33.
34.
Smolders M, Laurant M, Verhaak P, Prins M, van Marwijk H, Penninx B, Wensing M, Grol R. Adherence to evidence-based guidelines for depression and anxiety disorders is associated with recording of the diagnosis. Gen Hosp Psychiatry. 2009;31:460–9.CrossRef
35.
Magruder-Habib K, Zung WW, Feussner JR. Improving physicians’ recognition and treatment of depression in general medical care. Results from a randomized clinical trial. Med Care. 1990;28:239–50.CrossRef
36.
Gilbody SM, Whitty PM, Grimshaw JM, Thomas RE. Improving the detection and management of depression in primary care. Quality Safety Health Care. 2003;12:149–55.CrossRef
37.
Osteras N, Gulbrandsen P, Benth JS, Hofoss D, Brage S. Implementing structured functional assessments in general practice for persons with long-term sick leave: a cluster randomised controlled trial. BMC Fam Pract. 2009;10:31.CrossRef
38.
39.
Holmgren K, Hensing G, Bultmann U, Hadzibajramovic E, Larsson MEH. Does early identification of work-related stress, combined with feedback at GP-consultation, prevent sick leave in the following 12 months? A randomized controlled trial in primary health care. BMC Public Health. 2019;19:1110.CrossRef
Metadata
Title
Effects of a work stress intervention on healthcare use and treatment compared to treatment as usual: a randomised controlled trial in Swedish primary healthcare
Authors
Christine Sandheimer
Tove Hedenrud
Gunnel Hensing
Kristina Holmgren
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Care
Published in
BMC Primary Care / Issue 1/2020
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-020-01210-0

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