Behandling av stressrelaterade sjukdomar, med fokus på maladaptiv stressreaktion och utmattningssyndrom

Denna publikation publicerades för mer än två år sedan. Kunskapsläget kan ha förändrats.

Den stressrelaterade psykiska ohälsan har de senaste decennierna ökat i såväl Sverige som övriga västvärlden. För två stressrelaterade sjukdomar, maladaptiv stressreaktion (anpassningsstörning) och utmattningssyndrom (utbrändhet) är diagnos i många fall svår att ställa och det är oklart vilka behandlingsmetoder som är effektiva. 

Dessa stressrelaterade sjukdomar leder ofta till nedsatt funktionsförmåga och sjukskrivning.

Fråga till SBU:s Upplysningstjänst

Finns det studier som undersöker effekten av behandling inom primärvård
för personer med maladaptiv stressreaktion eller utmattningssyndrom?

Sammanfattning av Upplysningstjänstens svar

Upplysningstjänsten har totalt identifierat en systematisk översikt, en förstudie till en HTA-rapport (Health Technology Assessment), en klinisk riktlinje baserad på en systematisk litteratursökning, tre randomiserade kontrollerade studier samt två kontrollerade studier, som alla utvärderar behandlingar av personer med maladaptiv stressreaktion. De behandlingar som undersöks är bland annat psykodynamisk terapi och meditation.

En tysk HTA-rapport från år 2012 hittades som tar upp behandling av utmattningssyndrom. I rapporten ingår 17 primärstudier som bland annat utvärderar effekten av kognitiv beteendeterapi (KBT), rosenrot, qigong och meditation.

Sammantaget finns det endast ett fåtal studier där effekten av olika behandlingar utvärderas för personer med maladaptiv stressreaktion och fler studier behövs för att kunna kartlägga vilka metoder som har effekt. När det gäller behandling av utmattningssyndrom finns en HTA-rapport från år 2012. Författarna till HTA-rapporten drar slutsatsen att KBT är effektivt men ingen effektstorlek anges.

SBU har inte tagit ställning i sakfrågan eftersom de enskilda studiernas kvalitet inte bedömts och resultaten inte vägts samman. Här redovisas därför endast de enskilda författarnas slutsatser.

Detta är en uppdatering av SBU:s Upplysningstjänsts svar från 2012 på en avgränsad medicinsk fråga. Observera att det kan ha tillkommit nya studier efter litteratursökningsdatum: 2015-05-06.

Identifierad litteratur

Systematiska översikter

Arends, I. et al. Prevention of recurrent sickness absence in workers with common mental disorders: Results of a cluster-randomised controlled trial. Occupational and Environmental Medicine, 2014. 71(1): p. 21-29.

Korczak, D., M. Wastian, and M. Schneider. Therapie des Burnout-Syndroms. 2012, Deutschen Institut für Medizinische Dokumentation und Information (DIMDI): Köln.

Primärstudier

Stein, D.J. Etifoxine versus alprazolam for the treatment of adjustment disorder with anxiety: a randomized controlled trial. Adv Ther, 2015. 32(1):
p. 57-68.

Ben-Itzhak, S., et al. The Effectiveness of Brief Versus Intermediate Duration Psychodynamic Psychotherapy in the Treatment of Adjustment Disorder. Journal of Contemporary Psychotherapy, 2012: p. 1-8.

Srivastava, M., U. Talukdar, and V. Lahan. Meditation for the management of adjustment disorder anxiety and depression. Complement Ther Clin Pract, 2011. 17(4): p. 241-5.

Altenhöfer, A., et al. Psychotherapie von Anpassungsstörungen. Psychotherapeut, 2007. 52(1): p. 24-34.

van der Klink, J.J.L. and F.J.H. van Dijk. Dutch practice guidelines for managing adjustment disorders in occupational and primary health care. Scandinavian Journal of Work, Environment & Health, 2003. 29(6): p. 478-487.

Nguyen, N., et al. Efficacy of etifoxine compared to Lorazepam monotherapy in the treatment of patients with adjustment disorders with  


Publiceringsdatum

2015-06-16

Programchef

Jan Liliemark

Ansvarig utredare

Idha Kurtsdotter

Jessica Dagerhamn, jessica.dagerhamn@sbu.se

Övriga medarbetare

Madelene Lusth Sjöberg

Ladda ner rapport

SBU:s upplysningstjänst Systematisk litteratursökning som besvarar fråga från vården eller socialtjänsten om vilka relevanta översikter och studier som finns. Svaret utformas av medarbetare på SBU, vid behov med stöd av ämnessakkunnig. Systematisk kvalitetsgranskning görs inte.

Publicerad: 2015-06-16
Kontakta SBU: registrator@sbu.se
http://www.sbu.se/stressrelateradesjukdomar

Publikationer inom samma område

Litteratursökning

Litteratursökning till och med 2015-05-06

Databaser
PubMed via NLMk CRD, The Cochrane Library, The Cochrane Library via Wiley, Databas via ebsco, Embase via embase

Söktermer

PubMed via NLM 6 aug 2012

Stress i primärvården

 

Search terms

Items found

Population:

1.     

(((((("Adjustment Disorders"[Mesh]) OR Stress Disorder[Title/Abstract]) OR burnout[Title/Abstract]) OR "burn out"[Title/Abstract]) OR Reactive AND Disorder*[Title/Abstract]) OR Adjustment AND Disorder*[Title/Abstract]) OR Reactive AND Depression*[Title/Abstract]

8179

Intervention:

2.     

((("Family Practice"[Mesh]) OR "Primary Health Care"[Mesh]) OR "Physicians, Primary Care"[Mesh]) OR "General Practitioners"[Mesh]

122869

3.     

((((((general practi*[Title/Abstract]) OR family practi*[Title/Abstract]) OR family care[Title/Abstract]) OR primary health[Title/Abstract]) OR primary care[Title/Abstract]) OR gp[Title/Abstract]) OR health cent*[Title/Abstract]

160085

4.     

2 OR 3

221059

Final

1 AND 4

362

The search result, usually found at the end of the documentation,
forms the list of abstracts

 

[MeSH] = Term from the Medline controlled vocabulary, including
terms found below this term in the MeSH hierarchy

hierarchy

* = Truncation

“ “ = Citation Marks; searches for an exact phrase

 

CRD 13 aug 2012

Stress i primärvård

 

Search terms

Items found

Population:

1.

MeSH DESCRIPTOR Adjustment Disorders EXPLODE ALL TREES

OR (Stress Disorder) OR (burnout) OR ("burn out") OR (Reactive AND Disorder*) OR (Adjustment AND Disorder*) OR (Reactive AND Depression*)

331

Intervention:

2.

MeSH DESCRIPTOR General Practice EXPLODE ALL TREES

OR

MeSH DESCRIPTOR General Practitioners EXPLODE ALL TREES

OR

MeSH DESCRIPTOR Family Practice EXPLODE ALL TREES

OR

MeSH DESCRIPTOR Primary Health Care EXPLODE ALL TREES

OR

MeSH DESCRIPTOR Physicians, Primary Care EXPLODE ALL TREES

902

3.

( general practi*) OR (family practi*) OR ( family care) OR (primary health) OR (primary care) OR ( gp) OR ( health cent*)

5660

4.

2 OR 3

5746

Final

1 AND 4

58

The search result, usually found at the end of the documentation,
forms the list of abstracts

 

[MeSH] = Term from the Medline controlled vocabulary, including
terms found

* = Truncation

“ “ = Citation Marks; searches for an exact phrase 

 

Cochrane, 13 aug 2012

Stress i primärvård

 

Search terms

Items found

Population:

1.

MeSH descriptor Adjustment Disorders explode all trees or (Stress Disorder):ti,ab,kw or (burnout):ti,ab,kw or (Reactive AND Depression*):ti,ab,kw or (Reactive AND Disorder*):ti,ab,kw or (Adjustment AND Disorder*):ti,ab,kw or "burn out":ti,ab,kw

3667

Intervention:

2.

MeSH descriptor General Practice explode all trees OR MeSH descriptor Primary Health Care explode all trees OR MeSH descriptor General Practitioners explode all trees

4815

3.

general practi*:ti,ab,kw or family practi*:ti,ab,kw or family care:ti,ab,kw or primary health:ti,ab,kw or primary care:ti,ab,kw or gp:ti,ab,kw or health cent*:ti,ab,kw

28092

4.

2 OR 3

28358

Final

1 AND 4

423

CDSR: 30

DARE: 2

HTA: 1

EED: 4

The search result, usually found at the end of the documentation,
forms the list of abstracts

 

[MeSH] = Term from the Medline controlled vocabulary, including
terms found below this term in the MeSH hierarchy

[TI] = Title

[TIAB] = Title or abstract

[KW] = Key Word

* = Truncation

“ “ = Citation Marks; searches for an exact phrase

 

CDSR = Cochrane Database of Systematic Review

DARE = Database Abstracts of Reviews of Effects, “other reviews”

EED = Economic Evaluations

HTA = Health Technology Assessments 

 

Databas via ebsco.com 13 Aug 2012

Stress i primärvård

 

Search terms

Items found

Population:

1.     

DE "Adjustment Disorders" OR TI burnout OR TI "burn out" OR TI ( Reactive AND Disorder* ) OR TI ( Adjustment AND Disorder* ) OR TI ( Reactive AND Depression* ) OR

AB burnout OR AB "burn out" OR AB ( Reactive AND Disorder* ) OR AB ( Adjustment AND Disorder* ) OR AB ( Reactive AND Depression* )

15270

Intervention:

2.     

(DE "General Practitioners") OR (DE "Primary Health Care")

14080

3.     

TI general practi* OR TI family practi* OR TI family care OR TI primary health OR TI primary care OR TI gp OR TI health cent*

OR

AB general practi* OR AB family practi* OR AB family care OR AB primary health OR AB primary care OR AB gp OR AB health cent*

59776

4.     

2 OR 3

61761

Final

1 AND 4

509

The search result, usually found at the end of the documentation,
forms the list of abstracts

 

AB = Abstract

DE = Term from the thesaurus

TI = Title

* = Truncation

“ “ = Citation Marks; searches for an exact phrase 

 

PubMed via NLM 13 aug 2012

Stress i primärvård

 

Search terms

Items found

Population:

1.     

((((("Adjustment Disorders"[Mesh]) OR burnout[Title/Abstract]) OR "burn out"[Title/Abstract]) OR Reactive AND Disorder*[Title/Abstract]) OR Adjustment AND Disorder*[Title/Abstract]) OR Reactive AND Depression*[Title/Abstract]

5314

Intervention:

2.     

("Psychotherapy"[Mesh]) OR "Cognitive Therapy"[Mesh]

 

139061

3.     

(*therap*[Title/Abstract]) AND cognitive[Title/Abstract]

25603

4.     

2 OR 3

156198

Final

1 AND 4 limit "2007/08/01"[PDat] : "2012/08/27"[PDat]

192

The search result, usually found at the end of the documentation,
forms the list of abstracts

 

[MeSH] = Term from the Medline controlled vocabulary, including
terms found below this term in the MeSH hierarchy

* = Truncation

“ “ = Citation Marks; searches for an exact phrase

 

CRD 27 aug 2012

Stress i primärvården

 

Search terms

Items found

Population:

5.     

 MeSH DESCRIPTOR Adjustment Disorders EXPLODE ALL TREES OR (burnout) OR ("burn out") OR (Reactive AND Disorder*) OR (Adjustment AND Disorder*) OR (Reactive AND Depression*)

212

Intervention:

6.     

MeSH DESCRIPTOR Cognitive Therapy EXPLODE ALL TREES OR MeSH DESCRIPTOR Psychotherapy EXPLODE ALL TREES OR MeSH DESCRIPTOR Psychotherapy, Brief EXPLODE ALL TREES OR MeSH DESCRIPTOR Psychotherapy, Group EXPLODE ALL TREES

1339

7.     

(Cognitive AND Therapy ) OR (Psychotherapy) OR (psychoeducation) OR (group AND therapy)

9725

8.     

2 OR 3

9961

Final

1 AND 4

35

The search result, usually found at the end of the documentation,
forms the list of abstracts

 

[MeSH] = Term from the Medline controlled vocabulary, including
terms found below this term in the MeSH hierarchy

* = Truncation

“ “ = Citation Marks; searches for an exact phrase 

 

Cochrane 27 aug 2012

Stress i primärvården

 

Search terms

Items found

Population:

9.   

MeSH descriptor Adjustment Disorders explode all trees or (burnout):ti,ab,kw or (Reactive AND Depression*):ti,ab,kw or (Reactive AND Disorder*):ti,ab,kw or (Adjustment AND Disorder*):ti,ab,kw or "burn out":ti,ab,kw

1479

  Intervention:

10.  

MeSH descriptor Cognitive Therapy explode all trees or MeSH descriptor Psychotherapy, Brief explode all trees or MeSH descriptor Psychotherapy, Group, this term only

5109

11.  

(Cognitive AND Therapy ):ti,ab,kw or (Psychotherapy):ti,ab,kw or (psychoeducation):ti,ab,kw or (group AND therapy):ti,ab,kw

66173

12.  

2 OR 3

66173

Final

1 AND 4 from 2007 to 2012

133

CDSR: 7

HTA: 0

EED:2

The search result, usually found at the end of the documentation,
forms the list of abstracts

 

[MeSH] = Term from the Medline controlled vocabulary, including
terms found below this term in the MeSH hierarchy

[TI] = Title

[AB] = Abstract

[KW] = Title or abstract

[TW] = Text Word

* = Truncation

“ “ = Citation Marks; searches for an exact phrase

 

CDSR = Cochrane Database of Systematic Review

CRM = Method Studies

DARE = Database Abstracts of Reviews of Effects, “other reviews”

EED = Economic Evaluations 

 

Databas via ebsco.com PsycINFO 27 aug 2012

Maladaptiv stress

 

Search terms

Items found

Population:

13.  

DE "Adjustment Disorders" OR TI burnout OR TI "burn out" OR TI ( Reactive AND Disorder* ) OR TI ( Adjustment AND Disorder* ) OR TI ( Reactive AND Depression* ) OR

AB burnout OR AB "burn out" OR AB ( Reactive AND Disorder* ) OR AB ( Adjustment AND Disorder* ) OR AB ( Reactive AND Depression* )

15309

Intervention:

14.  

(DE "Cognitive Behavior Therapy") OR (DE "Psychotherapy")

47433

15.  

TI ( Cognitive AND Therapy ) OR TI Psychotherapy OR TI psychoeducation OR TI ( group AND therapy ) OR AB ( Cognitive AND Therapy ) OR AB Psychotherapy OR AB psychoeducation OR AB ( group AND therapy )

 

115414

16.  

2 OR 3

128127

Final

1 AND 4 Limiters - Published Date from: 20070801-20120831

255

The search result, usually found at the end of the documentation,
forms the list of abstracts

 

AB = Abstract

DE = Term from the thesaurus

TI = Title

* = Truncation

“ “ = Citation Marks; searches for an exact phrase

 

PubMed via NLM 5 maj 2015

Maladaptiv stress

 

Search terms

Items found

Population:

17.  

"Adjustment Disorders"[Mesh]

3881

18.  

burnout, professional[MeSH Terms]

7651

19.  

(((((stress disorder[Title/Abstract]) OR burnout[Title/Abstract]) OR "burn out"[Title/Abstract]) OR ((reactive[Title/Abstract]) AND disorder*[Title/Abstract])) OR ((adjustment[Title/Abstract]) AND disorder*[Title/Abstract])) OR ((reactive[Title/Abstract]) AND depression*[Title/Abstract])

43001

20.  

1 OR 2 OR 3

50225

Intervention:

21.  

((family practice[MeSH Terms]) OR primary health care[MeSH Terms]) OR general practitioners[MeSH Terms]

138648

22.  

((((general practi*[Title/Abstract]) OR family practi*[Title/Abstract]) OR family care[Title/Abstract]) OR primary health[Title/Abstract]) OR primary[Title/Abstract]

1121137

23.  

5 OR 6

1188892

Final

4 AND 7 AND ("2012/08/06"[Date - Publication] : "3000"[Date - Publication])

977

The search result, usually found at the end of the documentation,
forms the list of abstracts

 

[MeSH] = Term from the Medline controlled vocabulary, including
terms found below this term in the MeSH hierarchy

* = Truncation

“ “ = Citation Marks; searches for an exact phrase

 

Cochrane Library via Wiley 5 maj 2015

Maladadptiv stress

 

Search terms

Items found

Population:

24.  

MeSH descriptor: [Adjustment Disorders] explode all trees OR MeSH descriptor:[Burnout, Professional] explode all trees OR stress disorder:ti,ab,kw Publication Year from 2012 to 2015 (Word variations have been searched) OR "burnout":ti,ab,kw Publication Year from 2012 to 2015 (Word variations have been searched) OR "burn out":ti,ab,kw Publication Year from 2012 to 2015 (Word variations have been searched) OR reactive and disorder*:ti,ab,kw Publication Year from 2012 to 2015 (Word variations have been searched) OR adjustment and disorder*:ti,ab,kw Publication Year from 2012 to 2015 (Word variations have been searched) OR reactive and depression:ti,ab,kw Publication Year from 2012 to 2015 (Word variations have been searched)

2173

Intervention:

25.  

MeSH descriptor: [Family Practice] explode all trees or MeSH descriptor: [Primary Health Care] explode all trees or MeSH descriptor: [General Practitioners] explode all trees or general practi*:ti,ab,kw Publication Year from 2012 to 2015 (Word variations have been searched) or family practi*:ti,ab,kw Publication Year from 2012 to 2015 (Word variations have been searched) or family care:ti,ab,kw Publication Year from 2012 to 2015 (Word variations have been searched) or primary health:ti,ab,kw Publication Year from 2012 to 2015 (Word variations have been searched) or gp:ti,ab,kw Publication Year from 2012 to 2015 (Word variations have been searched) or health cent*:ti,ab,kw Publication Year from 2012 to 2015 (Word variations have been searched)

13549

Final

1 AND 2

253

CDSR: 29

DARE: 2

EED: 3

The search result, usually found at the end of the documentation,
forms the list of abstracts

 

[MeSH] = Term from the Medline controlled vocabulary, including
terms found below this term in the MeSH hierarchy

[TI] = Title

[AB] = Abstract

[KW] = Title or abstract

[TW] = Text Word

* = Truncation

“ “ = Citation Marks; searches for an exact phrase

 

CDSR = Cochrane Database of Systematic Review

CRM = Method Studies

DARE = Database Abstracts of Reviews of Effects, “other reviews”

EED = Economic Evaluations 

 

Embase via embase.com 2015-05-06

Maladaptiv stress

 

Search terms

Items found

Population:

26.  

   'adjustment disorder'/exp OR 'burnout'/exp

12797

27.  

stress AND disorder:ab,ti AND [embase]/lim OR 'burnout':ab,ti AND [embase]/lim OR 'burn out':ab,ti AND [embase]/lim OR reactive AND disorder*:ab,ti AND [embase]/lim OR adjustment AND disorder*:ab,ti AND [embase]/lim OR 'reactive depression':ab,ti AND [embase]/lim OR

68651

28.  

1 OR 2

76818

Intervention:

29.  

 'general practice'/exp OR 'primary health care'/exp OR 'general practitioner'/exp OR 'family medicine'/exp

227255

30.  

general AND practi*:ab,ti AND [embase]/lim OR family AND practi*:ab,ti AND [embase]/lim OR family AND care:ab,ti AND [embase]/lim OR primary AND health:ab,ti AND [embase]/lim OR 'gp':ab,ti AND [embase]/lim

695340

31.  

4 OR 5

822543

Final

3 AND 6 AND [2012-2015]/py

2774

The search result, usually found at the end of the documentation,
forms the list of abstracts

 

/exp= Includes terms found below this term in the EMTREE hierarchy

:ti:ab = Title or abstract

:py = publication year

* = Truncation

’ ’ = Citation Marks; searches for an exact phrase 

 

Databas via ebsco.com PsycINFO 2015-05-06

Maladaptiv stress

 

Search terms

Items found

Population:

32.  

   (DE "Adjustment Disorders")  OR  (DE "Occupational Stress")

17273

33.  

(TI stress disorder OR AB stress disorder) OR (TI burnout OR AB burnout) OR (TI "burn out" OR AB "burn out") OR (TI reactive disorder* OR AB reactive disorder*) OR (TI adjustment disorder* OR AB adjustment disorder*) OR (TI reactive depression OR AB reactive depression)

 38807

34.  

1 OR 2

49428

Intervention:

35.  

(((DE "Primary Health Care"))  OR  (DE "General Practitioners"))  OR  (DE "Family Physicians")

18661

36.  

(TI general practi* OR AB general practi*) OR (TI family practi* OR AB family practi*) OR (TI family care OR AB family care) OR (TI primary health OR AB primary health) OR (TI gp OR AB gp) OR (TI health cent* OR AB health cent*)

60079

37.  

4 OR 5

68946

Final

3 AND 6 AND DT 2012-2015

298

The search result, usually found at the end of the documentation, forms the list of abstracts

 

AB = Abstract

DE = Term from the thesaurus

TI = Title

* = Truncation

“ “ = Citation Marks; searches for an exact phrase