Effects of Additional Individually Tailored Interventions on Sick-Leave and Symptoms in Patients with Exhaustion Disorder: A Randomized Controlled Trial

Abstract

Objective: To evaluate the effects of adding individually tailored interventions to a standard treatment in patients with stress-related exhaustion disorder, with regard to sick-leave days and symptoms of burnout. The study design was a 2-armed randomized controlled intervention, with follow-up after 15 months. Data were obtained from patients referred to the Institute of Stress Medicine, and were collected between 2011 and 2014 in western Sweden.
Methods: Inclusion criteria were scoring above cut-off in at least 1 of 4 dimensions; mental and physical exhaustion, disturbed sleep, reduced cognitive function and perceived poor self-esteem. The total study population comprised 142 patients (112 females, 30 males) allocated through block randomization to either the intervention group (n = 71) or the control group (n = 71). The intervention group received 1–4 individually tailored interventions (physical activity, cognitive behaviour therapy for insomnia, computerized memory training, cognitive behavioural therapy for self-esteem), based on the results of screening assessments. The interventions were additional to a standard treatment. The control group received solely the standard treatment. The primary outcome measure was the proportion of participants not sicklisted at the 15-month follow-up.
Results: At the 15-month follow-up, 30% of subjects in the intervention group and 34% in the control group had 0% sick-listed (p = 0.58). No change between baseline and follow-up was seen in 42% of the intervention group and 39% of the control group, while an increased sick-leave rate was seen in 1% of the intervention group and 4% of the control group. However, no statistically significant difference was seen between groups.
Conclusion: Adding individually tailored interventions to a standard treatment in patients with stress-related exhaustion did not reduce sick-leave days or burnout symptoms.

LAY ABSTRACT
The aim of this randomized controlled study was to investigate whether individually tailored interventions, added to a standard treatment for patients diagnosed with stress-related exhaustion, could reduce sick-leave and symptoms of burnout more in the intervention group than in a control group. Patients were allocated randomly into either the intervention group or a control group. To be included in the study patients had to score above cut-off in 1 or more of the core dimensions characterizing stress-related exhaustion, mental and physical exhaustion, disturbed sleep, cognitive decline, or perceived poor self-esteem. Patients assigned to the intervention group received additional interventions as well as a standard treatment, while the control group received only standard treatment. The results showed no major differences between the intervention group and the control group, with respect to either sick-leave and symptoms of burnout at the 15-month follow-up. The clinical implication from this study is that individually tailored interventions added to the standard treatment are inefficient in reducing both sick-leave days and burden of disease in this patient group, and should be accompanied by interventions targeting the workplace and the work organization level.