Standardized multimodal intervention for stress-induced exhaustion disorder: an open trial in a clinical setting

Jakob Clason van de Leur, Monica Buhrman, Fredrik Åhs, Alexander Rozental, Gunilla Brodda Jansen, Jakob Clason van de Leur, Monica Buhrman, Fredrik Åhs, Alexander Rozental, Gunilla Brodda Jansen

Abstract

Background: Long-term sick-leave due to stress-related ill-health is increasing in several economically developed countries. Even though different forms of interventions are administered in regular care for stress-related disorders, such as Stress-induced Exhaustion disorder (SED), the scientific evidence for the effectiveness of such treatments is sparse. The objective of this study was to explore changes in SED-symptoms and return-to-work-rates in a large group of SED-patients participating in a standardized Multimodal intervention (MMI) in a clinical setting.

Method: This open clinical trial tracked 390 patients who fulfilled the criteria for SED undergoing a 24-week MMI, including return-to-work-strategies. Before inclusion, all patients underwent a multi-professional assessment by a team of licensed physicians, licensed psychologists, and licensed physiotherapists. Self-rated questionnaires were administered before treatment, at treatment-start, mid-treatment, post-treatment, and at 12-month follow-up. Within-group change was evaluated over time with mixed-effects models. Beyond different symptoms, working time, sick-leave compensation, and adverse effects were also measured.

Results: There were significant improvements in symptoms of SED, burnout, anxiety, depression, and insomnia, with large within-group effect sizes (d = 0.91-1.76), improvements that were maintained at 12-month follow-up. Furthermore, there was a significant increase in quality of life and large improvements in average working time and sick-leave compensation. Some adverse effects were reported, mainly concerning an increase in stress, anxiety, and worry.

Conclusion: SED-patients participating in this standardized MMI reported large symptom alleviation, increased working time and reduced sick-leave compensation, indicating a beneficial treatment. There were some adverse effects, but no more so than other psychological treatments. This study confirms previous findings that high levels of depression and anxiety decrease to sub-clinical levels during treatment, while symptoms of SED also decline, yet still persists above sub-clinical levels at 12-month follow-up. On the whole, this open clinical trial suggests that a standardized MMI, administered in a clinical setting, improves symptoms and return-to-work rates in a clinically representative SED-population.

Trial registration: This study was registered on Clinicaltrials.gov 2017.12.02 (Identifier: NCT03360136 ).

Keywords: Burnout; Long-term stress; Multimodal intervention; Negative effects; Rehabilitation; Stress-induced exhaustion disorder.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow of participants in the current study, together with reasons for dropping out throughout the trial
Fig. 2
Fig. 2
Overview of the 24-week Multimodal intervention for Stress-induced Exhaustion disorder in the current study
Fig. 3
Fig. 3
Changes in mean scores (intention-to-treat procedure) on Karolinska Exhaustion Disorder Scale in patients with Stress-induced Exhaustion disorder (N = 390) participating in a 24-week Multimodal intervention. Pre, before treatment; Start, treatment start; Mid-treatment, 12 weeks into treatment; Post, after treatment; 12MFU, 12-month follow-up
Fig. 4
Fig. 4
Changes in mean scores (intention-to-treat procedure) on the subscales depression and anxiety of the Hospital Anxiety and Depression Scale, in patients with Stress-induced Exhaustion disorder (N = 390) participating in a 24-week Multimodal intervention. Pre, before treatment; Start, treatment start; Mid-treatment, 12 weeks into treatment; Post, after treatment; 12MFU, 12-month follow-up

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