TIDAS – Early identification of work-related stress. A randomized controlled study in primary health care

Early identification of people at risk for sick-leave due to work-related stress – A randomized controlled study of people with mental disorders and physical complaints consulting primary health care

Background

There is no method or established practice in primary health care when it comes to the important issue of early identification of people at risk of sickness absence due to work-related stress. But work-related stress is common and can cause unhealthy and sick listing. Therefore, it is a vital question for society in general and primary health care in particular finding methods to early identify people at such risk. Both the individual and society can gain a lot from the prevention of absence, not the least since return to work is costly once a person is sick listed.

Both women and men see a doctor due to the symptoms, and a majority often goes to the primary health care, and this long before sick-listing comes into question. It could very well be that neither patient nor doctor is aware that the symptoms the patient describes are caused by work and the stress the patient is subject to there. There is, though, a questionnaire, the Work Stress Questionnaire (WSQ), that has been developed to early identify people at risk.

The project has close collaboration with primary care in Västra Götaland and is part of New Way's research program (https://www.gu.se/forskning/new-ways). 

The project is funded by Forte, VGR and the University of Gothenburg.

Aim

The overall purpose is to evaluate if a systematic use in Primary Health Care of the Work Stress Questionnaire (WSQ), including feedback from the general practitioner (GP), has an impact on the number of sick-leave days, pharmaceutical prescription and medical treatment and rehabilitation.

In total, 271 (intervention group, n = 132, control group, n = 139) non-sick-listed employed women and men, aged 18 to 64 years, who sought care at primary health care centers due to mental and physical health complaints participated in the study. 

Sickness absence was assessed from the Swedish Social Insurance Agency’s register MiDAS for registered sick-leave days (14 days or more) and self-reported sick-leave, pharmaceutical prescription from from the Swedish Prescribed Drug Register and medical treatment and rehabilitating from the Region Västra Götaland’s Vega register. 

Results

So far, the project has published 12 scientific articles, presented at several national and international conferences and contributed to the anthology ’Psykisk hälsa i arbetslivet’ (https://www.studentlitteratur.se/kompetensutveckling/medicin/psykiatri/psykisk-halsa-i-arbetslivet#show). Furthermore, three dissertations have been completed based on as a whole or in part on data from the project.

Registered sick leave was largely skewed, with a median of 0 sick leave days during follow-ups 12, 18 and 24 months. At 12-months follow-up approximately one third of the participants had registered sick leave. The mean days registered for the intervention group and the control group were 31 and 39 net days respectively, and 39 and 45 gross days respectively. At 18 and 24 months approximately 42% and 47% respectively had registered sick leave. The mean days for net days at 18 and 24 months in the intervention group were 42 and 55, in the control group 50 and 60.   

At 12-months follow-up of pharmaceutical prescription, the proportion of individuals who collected more than 10 different medications, and the proportion of individuals filling prescriptions issued from more than three different clinics was higher in the control group than in the intervention group. The number of different medications used per individual did not differ significantly between the groups. The follow-up of medical treatment and rehabilitating found among those with high level of work-related stress, a higher proportion receiving psychological treatment and collaborative care measures in the intervention group.

In a focus group study with the intervention-GPs, it emerged that GPs rejected work-related stress as part of their responsibility and emphasized that stress should not be seen as an illness. At the same time, they expressed a need for more knowledge about work-related stress and supportive resources.

Group members 

Kristina Holmgren
Professor 

Pernilla Bjerkeli
Docent och lektor vid högskolan i Skövde

Louise Danielsson
Docent och lektor

Jenny Hultqvist
Docent och lektor

Anna-Maria Hultén
Adjunkt

Kristin Lork
Lektor

Anna Frantz
Doktorand vid Karolinska institutet

Robin Fornazar
Projektassistent

Maria Dottori
Projektassistent vid FoU-centrum Göteborg och Södra Bohuslän 

Research partners

Gunnel Hensing 

Maria E.H Larsson

Dominique Hange

Cecilia Björkelund

Ute Bültman

Emina Hadzibajramovic

Publications 

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. 
Holmgren K, Fjällström Lundgren M, Hensing G 
Disabil Rehabil 2013 Mar;35(5):418-26

Arbetsrelaterad stress hos yrkesverksamma kvinnor som söker till primärvården för muskuloskeletala eller psykiska besvär. 
Holmgren K, Fjällström Lundgren M, Hensing G
Socialmedicinsk tidskrift 2011;5:436-444.

Tidig identifiering av arbetsrelaterad stress – En delrapport av TIDIG- PROJEKTET - Tidigt identifiering på vårdcentral av kvinnor som riskerar långtidssjukskrivning på grund av arbetsrelaterad stress.
Holmgren K, Hensing G, Fjällström Lundgren M.
Enheten för Socialmedicin. Avd. för samhällsmedicin och folkhälsa, Sahlgrenska akademin, Göteborgs universitet, 2010.