| 1. |
- Föyen, Ludwig Franke, et al.
(författare)
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Objective cognitive functioning in patients with stress-related disorders : a cross-sectional study using remote digital cognitive testing
- 2023
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Ingår i: BMC Psychiatry. - : Springer Nature. - 1471-244X. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patients with stress-related mental disorders often report cognitive impairment, but studies investigating objective cognitive impairment in patients with stress-related disorders have produced inconsistent findings. Aim: The primary aim of this study was to investigate objective cognitive functioning in patients diagnosed with the stress-related disorders adjustment disorder or exhaustion disorder, compared to a healthy normative group. Secondary aims were to conduct subgroup analyses of cognitive functioning between the diagnostic groups and explore associations between self-reported symptoms and cognitive functioning. Methods: Cognitive test results on a digitally self-administered cognitive test battery from 266 patients (adjustment disorder, n = 131; exhaustion disorder, n = 135) were cross-sectionally compared with results from a healthy normative group (N = 184 to 692) using one-tailed t-tests. ANOVAs were conducted for subgroup analyses, and regression analyses for associations between self-reported symptoms and cognitive functioning. Effect sizes were calculated. Results: Patients performed significantly worse than the normative group on all measures with small to moderate effect sizes ranging from d =-.13 to-.57. Those diagnosed with exhaustion disorder performed worse than norms on more measures than did patients with adjustment disorder, but no significant differences between diagnostic groups were found on any measure. Self-reported memory impairment was weakly associated with one of two memory measures. No clear associations between self-reported burnout symptoms and objective cognitive functioning were found. Conclusions: This study adds to the literature indicative of small to moderate objective cognitive impairments in patients diagnosed with stress-related mental disorders. Further exploration into mechanisms of cognitive functioning in different populations is needed for development of theoretical models that may explain the weak correlation between self-reported symptoms and objective measures.
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| 2. |
- Kolaas, Karoline, et al.
(författare)
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Internet-delivered transdiagnostic psychological treatments for individuals with depression, anxiety or both : a systematic review with meta-analysis of randomised controlled trials
- 2024
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 14:4
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Forskningsöversikt (refereegranskat)abstract
- Objective: Depression and anxiety are major public health problems. This study evaluated the effects of internet-delivered transdiagnostic psychological treatments for individuals with depression, anxiety, or both.Design: Systematic review with meta-analysis.Data sources: Medline (Ovid), Cochrane Library (Wiley), the Web of Science Core Collection (Clarivate), and PsycInfo (EBSCO) were searched on 24 May 2021, with an update on 6 February 2023.Eligibility criteria: Randomised controlled trials of internet-delivered transdiagnostic psychological treatments, open to both participants with primary depression and participants with primary anxiety. This review concerned all treatment frameworks, both guided and unguided formats and all age groups.Data extraction and synthesis: In random-effects meta-analysis, we estimated pooled effects on depression symptoms and anxiety in terms of Hedges' g with 95% CIs. Absolute and relative heterogeneity was quantified as the tau(2) and I-2.Results: We included 57 trials with 21 795 participants. Nine trials (16%) recruited exclusively from routine care, and three (5%) delivered treatment via video. For adults, large within-group reductions were seen in depression (g=0.90; 95% CI 0.81 to 0.99) and anxiety (g=0.87; 95% CI 0.78 to 0.96). Compared with rudimentary passive controls, the added effects were moderate (depression: g=0.52; 95% CI 0.42 to 0.63; anxiety: g=0.45; 95% CI 0.34 to 0.56) and larger in trials that required all participants to meet full diagnostic criteria for depression or an anxiety disorder. Compared with attention/engagement controls, the added effects were small (depression: g=0.30; 95% CI 0.07 to 0.53; anxiety: g=0.21; 95% CI 0.01 to 0.42). Heterogeneity was substantial, and the certainty of the evidence was very low. Two trials concerned adolescents and reported mixed results. One trial concerned older adults and reported promising results.Conclusion: Internet-delivered transdiagnostic treatments for depression and anxiety show small-to-moderate added effects, varying by control condition. Research is needed regarding routine care, the video format, children and adolescents and older adults.
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| 3. |
- Lindsäter, Elin, et al.
(författare)
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Characterization of exhaustion disorder and identification of outcomes that matter to patients : Qualitative content analysis of a Swedish national online survey
- 2023
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Ingår i: Stress and Health. - : John Wiley & Sons. - 1532-3005 .- 1532-2998. ; 39:4, s. 813-827
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Tidskriftsartikel (refereegranskat)abstract
- Fatigue is a common presenting problem in healthcare settings, often attributed to chronic psychosocial stress. Understanding of fatigue and development of evidence-based treatments is hampered by a lack of consensus regarding diagnostic definitions and outcomes to be measured in clinical trials. This study aimed to map outcome domains of importance to the Swedish diagnosis stress-induced exhaustion disorder (ED; ICD-10, code F43.8 A). An online survey was distributed nationwide in Sweden to individuals who reported to have been diagnosed with ED and to healthcare professionals working with ED patients. To identify outcome domains, participants replied anonymously to four open-ended questions about symptoms and expectations for ED-treatment. Qualitative content analysis was conducted of a randomized subsample of respondents, using a mathematical model to determine data saturation. Six hundred seventy participants (573 with reported ED, 97 healthcare professionals) completed the survey. Qualitative content analysis of answers supplied by 105 randomized participants identified 87 outcomes of importance to ED encompassing physical, cognitive, and emotional symptoms as well as functional disability. Self-rating scales indicated that many ED participants, beyond reporting fatigue, also reported symptoms of moderate to severe depression, anxiety, insomnia, poor self-rated health, and sickness behavior. This study presents a map of outcome domains of importance for ED. Results shed light on the panorama of issues that individuals with ED deal with and can be used as a step to further understand the condition and to reach consensus regarding outcome domains to measure in clinical trials of chronic stress and fatigue. Preregistration: Open Science Framework (osf.io) with DOI https://doi.org/10.17605/OSF.IO/4VUAG
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| 4. |
- Lindsäter, Elin
(författare)
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Cognitive behavioral therapy for stress-related disorders
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Stress-related disorders in the form of adjustment disorder (AD) and exhaustion disorder (ED) are prevalent and associated with significant suffering, functional impairment and high societal costs. Cognitive behavioral therapy (CBT) may be effective in reducing stress, but studies using clinical samples diagnosed with stress-related disorders are few, and evidence is lacking to support treatment guidelines. Because accessibility to CBT is limited, it is important to investigate treatment delivery formats that enable high scalability. Health economic evaluations of treatments are needed to guide decision makers in how to use limited healthcare resources efficiently. Further, the study of potential mediators of treatment effect is important to inform treatment development for patients diagnosed with AD or ED. Aims: The overall aim of Study I was to evaluate the effect of CBT, a return-to-work intervention (RTW-I), and a combination of the two (COMBO) for patients on sick leave due to a common mental disorder (CMD; AD, ED, anxiety disorders, depression, and insomnia). Of particular interest to the present thesis was to evaluate the effect of a new CBT protocol used to treat patients with stress-related disorders in Study I. In Study II, the aim was to evaluate the efficacy of that same CBT protocol when delivered as a therapist-guided internet-based treatment (ICBT) for individuals with AD or ED. In Study III, we aimed to investigate cost-effectiveness of the ICBT. In Study IV, we aimed to investigate sleep impairment as a putative mediator of the effect of ICBT on symptoms of stress and exhaustion. Methods: In Study I, consecutively recruited primary care patients (N = 211) who were on sick leave due to a CMD were randomized to disorder specific CBT, a RTW-I, or to COMBO. Main outcomes were symptom severity and net days on sick leave. Of the total sample, a majority (72%) of patients met diagnostic criteria for AD or ED and were treated with the new CBT protocol for stress-related disorders. In Study II, nationally recruited participants (N = 100) diagnosed with AD or ED were randomized to ICBT for stress-related disorders or to a waitlist control condition (WLC). Level of perceived stress was the main outcome. Studies III and IV were based on data collected in Study II. In Study III, cost- effectiveness and cost-utility of the ICBT were evaluated from a societal and a healthcare perspective, using remission rates and health-related quality of life to calculate incremental cost-effectiveness and cost-utility ratios respectively. In Study IV, weekly measurements of sleep impairment (the putative mediator) and outcomes (perceived stress and exhaustion) throughout the course of ICBT were analyzed using latent growth models within a structural equation framework. Results: Results of Studies I and II indicated that the CBT for stress-related disorders was effective in reducing symptoms compared with the RTW-I and the WLC respectively. Subgroup analyses of AD and ED in Study II indicated that the treatment was equally effective for both diagnostic groups. Treatment effect on sick leave (Study I) and work ability (Study II) was, however, small and non-significant compared with control conditions. Results from Study III suggested that, compared with the WLC, ICBT was a cost effective treatment, yielding large effects at no or minimal societal net costs in only 12 weeks. In Study IV, reduced sleep impairment was found to statistically mediate the effect of ICBT on symptoms of perceived stress and exhaustion. Conclusions: A relatively short CBT protocol designed to meet the presumed needs of patients diagnosed with AD or ED was indicated to be effective in reducing symptoms both when delivered as a face-to-face treatment and when delivered via the internet. If implemented in routine care, ICBT has the potential to increase access to efficacious treatment for many suffering individuals at no additional societal net costs. Reduced sleep impairment may be of importance to achieve successful treatment outcomes. The results motivate further investigation of the treatment using different control groups, longer follow- up periods, and more fine-grained evaluations of treatment mechanisms. Further investigation into interventions that may have an effect on work-related outcomes is warranted.
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| 5. |
- Lindsäter, Elin, et al.
(författare)
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Exhaustion disorder : scoping review of research on a recently introduced stress-related diagnosis
- 2022
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Ingår i: BJPsych Open. - : Cambridge University Press. - 2056-4724. ; 8:5
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundSymptoms related to chronic stress are prevalent and entail high societal costs, yet there is a lack of international consensus regarding diagnostics and treatment. A new stress-related diagnosis, exhaustion disorder, was introduced into the Swedish version of ICD-10 in 2005. Since then, use of the diagnosis has increased rapidly.AimsTo create the first comprehensive synthesis of research on exhaustion disorder to report on the current state of knowledge. Preregistration: Open Science Framework (osf.io), doi 10.17605/OSF.IO/VFDKW.MethodA PRISMA-guided scoping review of all empirical studies of exhaustion disorder was conducted. Searches were run in the MEDLINE, PsycInfo and Web of Science databases. Data were systematically charted and thematically categorised based on primary area of investigation.ResultsEighty-nine included studies were sorted into six themes relating to lived experience of exhaustion disorder (n = 9), symptom presentation and course (n = 13), cognitive functioning (n = 10), biological measures (n = 24), symptom measurement scales (n = 4) and treatment (n = 29). Several studies indicated that individuals with exhaustion disorder experience a range of psychiatric and somatic symptoms beyond fatigue, but robust findings within most thematic categories were scarce. The limited number of studies, lack of replication of findings and methodological limitations (e.g. small samples and scarcity of specified primary outcomes) preclude firm conclusions about the diagnostic construct.ConclusionsMore research is needed to build a solid knowledge base for exhaustion disorder. International collaboration regarding the conceptualisation of chronic stress and fatigue is warranted to accelerate the growth of evidence.
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| 6. |
- Lindsäter, Elin, et al.
(författare)
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Internet-Based Cognitive Behavioral Therapy for Chronic Stress : A Randomized Controlled Trial
- 2018
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Ingår i: Psychotherapy and Psychosomatics. - : S. Karger AG. - 0033-3190 .- 1423-0348. ; 87:5, s. 296-305
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Tidskriftsartikel (refereegranskat)abstract
- Background: Prolonged exposure to stress can lead to substantial suffering, impairment and societal costs. However, access to psychological treatment is limited. Internet-based cognitive behavioral therapy (ICBT) can be effective in reducing symptoms of stress, but little is known of its effects in clinical samples. The aim of this study was to investigate the efficacy of ICBT for patients suffering from chronic stress, operationalized as adjustment disorder (AD) and exhaustion disorder (ED). Methods: A total of 100 adults diagnosed with AD or ED were randomly assigned to a 12-week ICBT (n = 50) or waitlist control condition (n = 50). Primary outcome was the level of perceived stress (PSS). Secondary outcomes included several mental health symptom domains as well as functional impairment and work ability. All outcomes were assessed at baseline, after treatment and at the 6-month follow-up. The study was preregistered at Clinicaltrials.gov: NCT02540317. Results: Compared to the control condition, patients in the ICBT group made large and significant improvements on the PSS (d = 1.09) and moderate to large improvements in secondary symptom domains. Effects were maintained at the 6-month follow-up. There was no significant between-group effect on functional impairment or work ability. Conclusions: A relatively short ICBT is indicated to be effective in reducing stress-related symptoms in a clinical sample of patients with AD and ED, and has the potential to substantially increase treatment accessibility. Results must be replicated, and further research is needed to understand the relationship between symptom reduction, functional impairment and work ability.
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| 7. |
- Lindsäter, Elin, et al.
(författare)
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Psychometric and structural properties of the Karolinska Exhaustion Disorder Scale : a 1,072-patient study
- 2023
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Ingår i: BMC Psychiatry. - : BioMed Central (BMC). - 1471-244X. ; 23
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Exhaustion disorder is a stress-related diagnosis that was introduced in 2005 to the Swedish version of the International Statistical Classification of Diseases and Related Health Problems, 10th edition (ICD-10). The Karolinska Exhaustion Disorder Scale (KEDS) was developed to assess exhaustion disorder symptomatology. While the KEDS is intended to reflect a single construct and be used based on its total score, the instrument's characteristics have received limited attention. This study investigated the KEDS's psychometric and structural properties in a large clinical sample.Methods: The study relied on data from 1,072 patients diagnosed with exhaustion disorder that were included in two clinical trials in Sweden. We investigated the dimensionality, homogeneity, and reliability of the KEDS using advanced statistical techniques, including exploratory structural equation modeling (ESEM) bifactor analysis.Results: A one-factor confirmatory analytic model exhibited a poor fit, suggesting at least a degree of multidimensionality. The ESEM bifactor analysis found the general factor to explain about 72% of the common variance extracted, with an omega hierarchical coefficient of 0.680. Thus, the ESEM bifactor analysis did not clearly support the scale's essential unidimensionality. A homogeneity analysis revealed a scale-level H of only 0.296, suggesting that KEDS's total scores do not accurately rank individuals on the latent continuum assumed to underlie the measure. The KEDS's reliability was modest, signaling considerable measurement error.Conclusion: Findings reveal important limitations to the KEDS with possible implications for the status of exhaustion disorder as a nosological category.
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| 8. |
- Lindsäter, Elin, et al.
(författare)
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The mediating role of insomnia severity in internet-based cognitive behavioral therapy for chronic stress : Secondary analysis of a randomized controlled trial
- 2021
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Ingår i: Behaviour Research and Therapy. - : Elsevier BV. - 0005-7967 .- 1873-622X. ; 136
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate insomnia symptom severity as a putative mediator of treatment response in therapist-guided internet-based cognitive behavioral therapy (ICBT) for chronic stress, using data from a randomized controlled trial. Participants (N = 100) were randomized to 12 weeks of ICBT or to a waitlist control condition (WLC). Insomnia severity was assessed weekly with the Insomnia Severity Index (ISI), as were the stress-related outcomes the Perceived Stress Scale (PSS) and the Shirom-Melamed Burnout Questionnaire (SMBQ). Latent growth models indicated that ICBT (vs. WLC) predicted a decrease in insomnia severity (alpha-path), and that growth in insomnia severity was predictive of growth in perceived stress and exhaustion (beta-paths). Most importantly, there were also significant indirect effects (alpha beta products) such that the beneficial effects of ICBT on perceived stress and exhaustion were mediated by a reduction in insomnia symptom severity (PSS: alpha beta =-0.44, 95% CI [-0.92,-0.14]; SMBQ: alpha beta =-0.08, 95% CI [-0.15, 0.04]). Explorative analysis of moderated mediation showed that more severe insomnia symptoms at baseline were associated with larger mediated effects. We conclude that reducing insomnia severity could be of importance for achieving successful treatment outcomes in ICBT for chronic stress.
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| 9. |
- Rück, Christian, et al.
(författare)
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DN Debatt: "De utmattade måste få tillgång till rätt vård"
- 2022
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Ingår i: Dagens Nyheter. - 1101-2447.
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Nio forskare: Kunskapsbristerna som fanns vid införandet av diagnosen utmattningssyndrom är fortfarande lika stora. Nya kriterier håller nu på att tas fram utan att de först har utvärderats vetenskapligt.
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| 10. |
- Salomonsson, Sigrid, et al.
(författare)
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Cognitive-behavioural therapy and return-to-work intervention for patients on sick leave due to common mental disorders : a randomised controlled trial
- 2017
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Ingår i: Occupational and Environmental Medicine. - : BMJ. - 1351-0711 .- 1470-7926. ; 74:12, s. 905-912
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Common mental disorders (CMDs) cause great individual suffering and long-term sick leave. Cognitive–behavioural therapy (CBT) effectively treats CMDs, but sick leave is not reduced to the same extent as psychiatric symptoms. Research results regarding return-to-work interventions (RTW-Is) and their effect on sick leave are inconclusive. The aim of this study was to evaluate CBT, a RTW-I and combined CBT and RTW-I (COMBO) for primary care patients on sick leave due to CMDs.Methods Patients with CMDs (n=211) were randomised to CBT (n=64), RTW-I (n=67) or COMBO (n=80). Sick-leave registry data after 1 year and blinded Clinician’s Severity Rating (CSR) of symptoms post-treatment and at follow-ups after 6 and 12 months were primary outcomes.Results There was no significant difference between treatments in days on sick leave 1 year after treatment start (mean difference in sick-leave days range=9–27). CBT led to larger reduction of symptoms post-treatment (CSR; Cohen’s d=0.4 (95% CI 0.1 to 0.8)) than RTW-I, whereas COMBO did not differ from CBT or RTW-I. At follow-up, after 1 year, there was no difference between groups. All treatments were associated with large pre-treatment to post-treatment improvements, and results were maintained at 1-year follow-up.Conclusion No treatment was superior to the other regarding reducing sick leave. All treatments effectively reduced symptoms, CBT in a faster pace than RTW-I, but at 1-year follow-up, all groups had similar symptom levels. Further research is needed regarding how CBT and RTW-I can be combined more efficiently to produce a larger effect on sick leave while maintaining effective symptom reduction.
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