Early identification of primary health care patients at risk of sick leave due to work-related stress
Aim: Work-related stress and sick leave are common among primary health care patients, and general practitioners (GPs) often handle cases involving stress and work capacity in their daily practices. This thesis aimed to improve the understanding of how to early identify primary health care patients at risk of sick leave due to work-related stress. Methods: The four studies included in the thesis are based on a two-armed randomized controlled trial evaluating a brief intervention in which the Work Stress Questionnaire (WSQ) was used to screen for work-related stress. In all, 271 patients seeking care for mental and physical health complaints and 63 GPs took part. The first two studies evaluated the process and effectiveness of using the intervention based on focus group discussions, questionnaire data, and data collected by telephone or e-mail. The last two studies analysed the association between work-related stress, reason for consultation, and sick leave based on questionnaire and register data. Focus group analysis and statistical analysis were used in analysing the data retrieved. Results: Study I showed that the intervention was not seen as useful by the GPs, as they had to depart from their regular consultative way of working. They also expressed a need for increased skills, tools, and team collaboration to care for patients with work-related stress. Study II could not show that the intervention affected future self-reported sick leave among the patients. Study III showed that influence at work, indistinct organization and conflicts, individual demands and commitment, as well as interference between work and leisure time affected the risk of future registered sick leave, especially if the patients perceived stressors and stress in multiple areas. Study IV showed that the reason for consultation and the sick leave diagnosis merit consideration when studying the association between work-related stress and sick leave, and that work-related stress is seen mainly as a mental issue from the perspectives of both the GP and patient. Conclusions: The thesis confirms prior studies of the association between work-related stress and sick leave among primary health care patients, and also highlights factors along the illness–sickness–sick leave trajectory that are important for the association. Knowledge was also gained of the GPs’ handling of cases involving stress-related ill health and the prerequisites for implementing a preventive intervention. Overall, the thesis advances the discussion of how stress should be conceptualized and measured as well as how to handle the negative health effect of stress.
Parts of work
I. Hultén AM, Dahlin-Ivanoff S, Holmgren K. Positioning work related stress - GPs' reasoning about using the WSQ combined with feedback at consultation. BMC Fam Pract. 2020;21(1):187. http://doi.org/10.1186/s12875-020-01258-yII. Hultén A-M, Bjerkeli P, Holmgren K. Self-reported sick leave following a brief preventive intervention on work-related stress: a randomised controlled trial in primary health care. BMJ Open. 2021;11(3):e041157. http://doi.org/10.1136/bmjopen-2020-041157III. Hultén AM, Bjerkeli P, Holmgren K. Work-related stress and future sick leave in a working population seeking care at primary health care centres: a prospective longitudinal study using the WSQ. BMC Public Health. 2022;22(1):851. http://doi.org/10.1186/s12889-022-13269-8IV. Hultén A-M, Holmgren K, Bjerkeli P. Work-related stress, reason for consultation and diagnosis-specific sick leave: How do they add up? Submitted for publication.
Doctor of Philosophy (Medicine)
University of Gothenburg. Sahlgrenska Academy
Institute of Neuroscience and Physiology. Department of Health and Rehabilitation
Fredagen den 24 mars 2023, kl. 9.00, Hörsal Arvid Carlsson, Medicinaregatan 3, Göteborg https://gu-se.zoom.us/j/69967891502?pwd=dk1rUzA1REd3S0JNcDI1ZVpYV3YxZz09
Date of defence
Mental and physical complaints
Primary health care patients
Work Stress Questionnaire (WSQ)