Does a brief work-stress intervention prevent sick-leave during the following 24 months? A randomized controlled trial in Swedish primary care

BACKGROUND: Work-related stress (WRS) presents a risk for sick leave. However, effective methods to identify people at risk for sick leave due to WRS at an early stage are lacking in primary health care. OBJECTIVE: To evaluate whether a systematic early identification of WRS can prevent sick leave over 24 months after the intervention. METHODS: Study participants (n = 132 intervention; n = 139 control) were employed, non-sick-listed persons seeking care at primary health care centres. The intervention included early identification of WRS by a validated instrument, general practitioner (GP) awareness supported by a brief training session, patients’ self-reflection by instrument completion, GP giving the patient feedback at consultation and GP identifying preventive measures. The control group received treatment as usual. Outcome data were retrieved from the Swedish Social Insurance Agency. RESULTS: The intervention group had less registered median sick leave days (n = 56) than the control group (n = 65) but the difference was not statistically significant. CONCLUSIONS: The brief intervention was not proven effective in preventing sick leave in the following 24 months compared to treatment as usual. Further research on how to identify, advice and treat those at high risk for sick leave in primary health care is needed.

[1]  G. Hensing,et al.  Effects of a work stress intervention on healthcare use and treatment compared to treatment as usual: a randomised controlled trial in Swedish primary healthcare , 2020, BMC Family Practice.

[2]  I. Skoglund,et al.  Does early identification of high work related stress affect pharmacological treatment of primary care patients? - analysis of Swedish pharmacy dispensing data in a randomised control study , 2020, BMC Family Practice.

[3]  M. Ingvar,et al.  Effects of cognitive behavioural therapy and return-to-work intervention for patients on sick leave due to stress-related disorders: Results from a randomized trial. , 2020, Scandinavian journal of psychology.

[4]  R. Sjöström,et al.  Patients’ Experiences of a Stress-Management Programme in Primary Care , 2020, Journal of multidisciplinary healthcare.

[5]  K. Holmgren,et al.  The Work Stress Questionnaire (WSQ) – reliability and face validity among male workers , 2019, BMC Public Health.

[6]  J. Twisk,et al.  Development of Prediction Models for Sickness Absence Due to Mental Disorders in the General Working Population , 2019, Journal of Occupational Rehabilitation.

[7]  U. Bültmann,et al.  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 , 2019, BMC Public Health.

[8]  S. Bernhardsson,et al.  Symptoms that may be stress-related and lead to exhaustion disorder: a retrospective medical chart review in Swedish primary care , 2018, BMC Family Practice.

[9]  C. Brisson,et al.  Effect of psychosocial work factors on the risk of certified absences from work for a diagnosed mental health problem: a protocol of a systematic review and meta-analysis of prospective studies , 2018, BMJ Open.

[10]  J. Knottnerus,et al.  Training GPs to improve their management of work-related problems: results of a cluster randomized controlled trial , 2018, The European journal of general practice.

[11]  R. de Graaf,et al.  Job strain as a risk factor for clinical depression: systematic review and meta-analysis with additional individual participant data , 2017, Psychological Medicine.

[12]  C. Björkelund,et al.  Use of a self-rating scale to monitor depression severity in recurrent GP consultations in primary care – does it really make a difference? A randomised controlled study , 2017, BMC Family Practice.

[13]  O. Pietiläinen,et al.  Short sickness absence and subsequent sickness absence due to mental disorders - a follow-up study among municipal employees , 2017, BMC Public Health.

[14]  U. Bültmann,et al.  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) , 2016, BMC Public Health.

[15]  Kristian Skagen,et al.  The consequences of sickness presenteeism on health and wellbeing over time: A systematic review. , 2016, Social science & medicine.

[16]  K. Hergenrather,et al.  Employment as a Social Determinant of Health: A Review of Longitudinal Studies Exploring the Relationship Between Employment Status and Mental Health , 2015, Rehabilitation Research, Policy, and Education.

[17]  B. Fridlund,et al.  Impact of the organisational culture on primary care staff members' intention to engage in research and development. , 2015, Journal of health organization and management.

[18]  K. Hergenrather,et al.  Employment as a Social Determinant of Health: A Systematic Review of Longitudinal Studies Exploring the Relationship Between Employment Status and Physical Health , 2015, Rehabilitation Research, Policy, and Education.

[19]  S. Knardahl,et al.  Psychological and Social Work Factors as Predictors of Mental Distress: A Prospective Study , 2014, PloS one.

[20]  M. Åsberg,et al.  Symptom reduction due to psychosocial interventions is not accompanied by a reduction in sick leave: Results from a randomized controlled trial in primary care , 2014, Scandinavian journal of primary health care.

[21]  P. Dark,et al.  Extralaryngeal branching of the recurrent laryngeal nerve: a meta-analysis of 28,387 nerves , 2013, Langenbeck's Archives of Surgery.

[22]  B. Netterstrøm,et al.  Effects of a Multidisciplinary Stress Treatment Programme on Patient Return to Work Rate and Symptom Reduction: Results from a Randomised, Wait-List Controlled Trial , 2013, Psychotherapy and Psychosomatics.

[23]  G. Hensing,et al.  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 , 2013, Disability and rehabilitation.

[24]  E. Söderberg,et al.  Primary Healthcare Professionals’ Experiences of the Sick Leave Process: A Focus Group Study in Sweden , 2013, Journal of Occupational Rehabilitation.

[25]  Thomas Kraus,et al.  Psychosocial work stressors as antecedents of musculoskeletal problems: a systematic review and meta-analysis of stability-adjusted longitudinal studies. , 2012, Social science & medicine.

[26]  C. Lindholm,et al.  Is There an Association between Long-Term Sick Leave and Disability Pension and Unemployment beyond the Effect of Health Status? – A Cohort Study , 2012, PloS one.

[27]  Reiner Rugulies,et al.  The impact of work-related psychosocial stressors on the onset of musculoskeletal disorders in specific body regions: A review and meta-analysis of 54 longitudinal studies , 2011 .

[28]  M. Frings-Dresen,et al.  Psychosocial work environment and stress-related disorders, a systematic review. , 2010, Occupational medicine.

[29]  W. Stalman,et al.  Training GP's to use a minimal intervention for stress-related mental disorders with sick leave (MISS): Effects on performance: Results of the MISS project; a cluster-randomised controlled trial [ISRCTN43779641]. , 2010, Patient education and counseling.

[30]  M. Barry.  Addressing the Determinants of Positive Mental Health: Concepts, Evidence and Practice , 2009 .

[31]  K. Dunn,et al.  Identification of UK sickness certification rates, standardised for age and sex. , 2009, The British journal of general practice : the journal of the Royal College of General Practitioners.

[32]  S. Vollset,et al.  Sickness absence with musculoskeletal or mental diagnoses, transition into disability pension and all-cause mortality: A 9-year prospective cohort study , 2009, Scandinavian journal of public health.

[33]  G. Hensing,et al.  Development of a questionnaire assessing work-related stress in women – identifying individuals who risk being put on sick leave , 2009, Disability and rehabilitation.

[34]  G. Waddell,et al.  Vocational rehabilitation – what works, for whom, and when?(Report for the Vocational Rehabilitation Task Group) , 2008 .

[35]  J. Bonde.  Psychosocial factors at work and risk of depression: a systematic review of the epidemiological evidence , 2008, Occupational and Environmental Medicine.

[36]  W. Stalman,et al.  A Cluster-Randomised Trial Evaluating an Intervention for Patients with Stress-Related Mental Disorders and Sick Leave in Primary Care , 2007, PLoS clinical trials.

[37]  I. Kant,et al.  Long-term efficacy of cognitive-behavioral therapy by general practitioners for fatigue: a 4-year follow-up study. , 2006, Journal of psychosomatic research.

[38]  B. Terluin,et al.  Effectiveness of an intervention to reduce sickness absence in patients with emotional distress or minor mental disorders: a randomized controlled effectiveness trial. , 2006, General hospital psychiatry.

[39]  L. Frostholm,et al.  Mental disorders in primary care: prevalence and co-morbidity among disorders. Results from the Functional Illness in Primary care (FIP) study , 2005, Psychological Medicine.

[40]  G. Hensing.  Chapter 4. Methodological aspects in sickness-absence research , 2004, Scandinavian journal of public health. Supplement.

[41]  J. Knottnerus,et al.  Efficacy of cognitive–behavioural therapy by general practitioners for unexplained fatigue among employees , 2004, British Journal of Psychiatry.

[42]  S. Ivanoff,et al.  Women on sickness absence—views of possibilities and obstacles for returning to work. A focus group study , 2004, Disability and rehabilitation.

[43]  G. Pransky,et al.  Improving the physician role in evaluating work ability and managing disability: a survey of primary care practitioners , 2002, Disability and rehabilitation.

[44]  T. Bjerkedal,et al.  Epidemiology of Sickness Certification— , 1989, Scandinavian journal of social medicine.

[45]  Tom Cox,et al.  The Cost of Work-Related Stress to Society: A Systematic Review , 2018, Journal of occupational health psychology.

[46]  Kirk Reed,et al.  Focusing on employment in primary mental health care: A scoping review. , 2018, Work.

[47]  A. J. van der Beek,et al.  Communication about work between general practitioners and patients consulting for musculoskeletal disorders. , 2009, Quality in primary care.

[48]  M. Labriola.  Conceptual framework of sickness absence and return to work, focusing on both the individual and the contextual level. , 2008, Work.

[49]  S. Marklund,et al.  What is healthy work for women and men? - A case-control study of gender- and sector-specific effects of psycho-social working conditions on long-term sickness absence. , 2006, Work.