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

Lästid: ca 14 min Publicerad: Publikationstyp:

SBU:s upplysningstjänst

Strukturerad litteratur­sökning som besvarar fråga från vården eller social­tjänsten om vilka relevanta översikter och studier som finns. Vi bedömer risken för bias i systematiska översikter och vid behov även kvalitet och över­förbarhet av resultaten i hälso­ekonomiska studier. Svaret utformas av medarbetare på SBU, vid behov med stöd av ämnessakkunnig.

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 anxiety: A double-blind controlled study in general practice. Human Psychopharmacology: Clinical and Experimental, 2006. 21(3): p. 139-149.

Publiceringsdatum

2015-06-16

Programchef

Jan Liliemark

Ansvarig utredare

Idha Kurtsdotter

Jessica Dagerhamn

Övriga medarbetare

Madelene Lusth Sjöberg

Kontakta SBU
Publicerad: https://www.sbu.se/stressrelateradesjukdomar
Till toppen

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

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
  Search terms tems 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
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

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
  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
Databas via ebsco.com 13 Aug 2012
Stress i primärvård

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
  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
PubMed via NLM 13 aug 2012
Stress i primärvård

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
  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
CRD 27 aug 2012
Stress i primärvården

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
  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
Cochrane 27 aug 2012
Stress i primärvården

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
  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
Databas via ebsco.com PsycINFO 27 aug 2012
Maladaptiv stress

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
  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
PubMed via NLM 5 maj 2015
Maladaptiv stress

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
  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
Cochrane Library via Wiley 5 maj 2015
Maladadptiv stress

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
  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
Embase via embase.com 2015-05-06
Maladaptiv stress

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
  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
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

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