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Impact of group interventions on stress and sleep problems in primary care
Umeå University, Faculty of Social Sciences, Department of Psychology. (Hälsa Utbildning Stress Sömn (HUSS))ORCID iD: 0000-0002-2408-3205
Umeå University, Faculty of Social Sciences, Department of Psychology. (Hälsa Utbildning Stress Sömn (HUSS))ORCID iD: 0000-0002-4411-3803
Umeå University, Faculty of Social Sciences, Department of Psychology. (Hälsa Utbildning Stress Sömn (HUSS))ORCID iD: 0000-0003-1699-1681
Umeå University, Faculty of Social Sciences, Department of Psychology. (Hälsa Utbildning Stress Sömn (HUSS))ORCID iD: 0000-0002-7193-2118
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objectives: The majority of patients who seek help for stress and sleep problems do so in primary health care in Sweden. However, the resources for psychological treatment are limited. The aim of this study was to assess the effectiveness of a low-intensity student-led group interventions, applying cognitive behavioral therapy (CBT) with an indicated prevention approach in primary care for recovery and reducing symptoms of stress and sleep disturbance.

Methods: Using a quasi-experimental design, interventions were conducted for stress (n=274, mean age=38 years, 75% women) and sleep (n=106, mean age=44 years, 56% women) problems in consecutively recruited primary care patients. These were compared with a control group (n=221, mean age=45 years, 91% women) recruited via social media. The interventions were CBT-based psychoeducative group interventions that consisted of four 90-min sessions and led by psychology students. Assessment was completed at pre- and post-intervention and at 3-month follow-up. Main outcome measures were the 10-item Perceived Stress Scale and the Shirom-Melamed Burnout Questionnaire for the stress intervention, and the Karolinska Sleep Questionnaire for the sleep intervention. The Hospital Anxiety and Depression Scale and the 15-item Patient Health Questionnaire were used to assess anxiety, depression and somatization as secondary outcome measures for both interventions. Analysis of covariance (pre- vs post-intervention) and reliable change index (pre-intervention vs three-month follow-up) were applied.

Results: Statistically significant, but small effects of improved health in comparison to the control group were found on stress and burnout (η2=.021-.030) in the stress intervention, and on sleep (η2=.017) in the sleep intervention. The proportion of patients in the stress intervention with a reliable improvement at three-month follow-up was 28% for stress and 59% for burnout, and 0% and 33%, respectively, for the control group. Among those with a reliable improvement in burnout, 31% also met a recovery criterion (<4.0). In the sleep intervention, 25% of the patients showed a reliable improvement in sleep and 61% in burnout, and 6% and 33%, respectively, for the control group. The effects of the stress intervention were statistically significant, but small on anxiety and depression (η2=.021-.047), as were the effects of the sleep intervention on stress and burnout (η2=.017-.026). 

Conclusion: The results suggest that psychology students can effectively provide a low-intensity group-delivered CBT intervention for patients exhibiting symptoms of stress, burnout and sleep disturbance in routine general medical practice, offering promising opportunities for scalability expansion. Although the average treatment effects were small, a substantial proportion of the patients showed reliable improvement or recovery at 3-month follow-up. This suggests that the interventions decrease the prevalence of burnout and sleep disturbance or improve the well-being of individuals experiencing mental distress. 

Keywords [en]
Stress, burnout, adjustment disorder, insomnia, stepped care, low-intensity psychological intervention
National Category
Other Health Sciences Psychology
Research subject
Clinical Psychology; Psychology
Identifiers
URN: urn:nbn:se:umu:diva-222830OAI: oai:DiVA.org:umu-222830DiVA, id: diva2:1847541
Funder
AFA Insurance, 190082Available from: 2024-03-28 Created: 2024-03-28 Last updated: 2024-04-02
In thesis
1. Stress, sleep disturbance, and related ill-health: from prevalence and risk-factors to indicated interventions
Open this publication in new window or tab >>Stress, sleep disturbance, and related ill-health: from prevalence and risk-factors to indicated interventions
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

With focus on stress-related ill-health and insomnia/sleep disturbance, the overall aim of this thesis was to determine severity and prevalence, risk factors and effectiveness of low-intensity group sessions. This was accomplished by taking epidemiological and quasi-experimental approaches. 

With the aim of examining symptom severity and prevalence of insomnia, burnout, anxiety, depression, and somatization across different age groups and sexes, Study I used cross-sectional data (n=3406) from the baseline data collection of the Västerbotten Environmental Health Study (VEHS). In comparison to men, women in most age groups exhibited higher levels of symptom severity and prevalence of caseness in various mental health conditions. Insomnia (28.6%) and burnout (17.3%) were common in the population.

With focus on risk factors for insomnia and burnout, Study II used a longitudinal design and VEHS data (n=1702–1972) to compare a range of mental and somatic conditions in a general population. The results showed that all examined health conditions were risk factors for cases of insomnia and burnout. For example, insomnia can increase the risk of developing burnout (odds ratio: 2.67), and burnout increase the risk of developing insomnia (odds ratio: 2.73), underscoring the importance of early detection and prevention. 

The aim of Study III was to examine the effectiveness of four low-intensity group sessions for stress (n=274) and sleep disturbance (n=106) conducted by psychology students. A non-randomized controlled trial design was used in primary care with naturally occurring groups. A control group (n=221) was recruited via social media. Whereas effects were small at post-treatment, a substantial proportion of the patients showed a reliable improvement or recovery at 3-month follow-up. 

This thesis provides support for the assumption that severity and prevalence of insomnia, burnout, anxiety, depression, and somatization are common in the population. Burnout and insomnia are mutual risk factors and underscore the importance of indicated prevention in primary care. Low-intensity group interventions facilitated by non-experts can be effective and scalable for patients with stress and sleep disturbance.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2024. p. 118
Keywords
Stress-related ill-health, Prevalence, Risk factors, Burnout, Insomnia, Non-experts, Low intensity psychological interventions, Primary care, Scalability, Indicated prevention.
National Category
Psychology
Research subject
Clinical Psychology; Epidemiology
Identifiers
urn:nbn:se:umu:diva-222832 (URN)978-91-8070-264-5 (ISBN)978-91-8070-265-2 (ISBN)
Public defence
2024-04-26, UB A.240, Lindellhallen 4, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2024-04-05 Created: 2024-03-28 Last updated: 2024-04-02Bibliographically approved

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Höglund, PerHakelind, CamillaNordin, StevenSundström, AnnaNordin, Maria

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