Abstract
BackgroundWork 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.MethodsA 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).ResultsA 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.ConclusionsThe 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 registrationClinicalTrials.gov. Identifier: NCT02480855. Registered 20 May 2015.
Highlights
IntroductionIdentifying early symptoms of work stress in primary healthcare (PHC) could result in earlier and better-targeted care
Work stress is an increasing burden in society
The intervention group that used the Work Stress Questionnaire (WSQ) with physicians’ feedback had an increased number of rehabilitative measures and treatment more in line with established guidelines compared to treatment as usual
Summary
Identifying early symptoms of work stress in primary healthcare (PHC) could result in earlier and better-targeted care. Common mental disorders (CMDs) such as stressrelated ill health, depression and anxiety disorders, are an increasing universal burden for the affected individuals but for the society at large [1, 2]. It is well established that high work burden with minimal possibility to control or influence the work situation, as well as existing conflicts, can lead to distress and increases the risk for future ill health [10,11,12]. A Swedish cross-sectional study [16] conducted in primary healthcare (PHC) revealed that 59% of all patients aged 18–65 seeking care at a primary healthcare centre (PHCC), regardless of cause, reported high mental stress levels. The underlying stress is not identified by the healthcare service until very late in the care process, when sick listing has become unavoidable [17]
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