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Karolinska Institute

1. Salomonsson, Sigrid. CBT in primary care : effects on symptoms and sick leave, implementation of stepped care and predictors of outcome .

Degree: 2018, Karolinska Institute

Background Common mental disorders (CMDs) cause great individual suffering and high societal costs including long-term sick leave. Cognitive behavioural therapy (CBT) can effectively treat CMDs, but access to treatment is insufficient. Moreover, sick leave is not reduced to the same extent as psychiatric symptoms after CBT. Little is known about predictors of outcome after CBT, especially concerning guided self-help. Aims The aim of the present thesis was to systematically review the effects and evidence of psychological treatments on sick leave and assess the effects in a meta-analysis of published treatment trials (Study I), evaluate the effect of CBT and a novel return-to-work intervention (RTW-I) on sick leave and psychiatric symptoms for patients with CMDs (Study II), test a stepped care CBT model for CMDs in primary care (Study III), and investigate predictors of outcome for guided self-help CBT (Study IV). Methods In Study I, a systematic review and meta-analysis (45 studies) was conducted regarding effects of psychological interventions on sick leave and symptoms. In Study II (N = 211) and III (N = 396) patients from four primary care centres in Stockholm were treated with disorder specific CBT for CMDs. In Study II, patients on sick leave were randomised to CBT, RTW-I, or a combination of the two, and were followed up one year after treatment regarding sick leave and symptoms. In Study III all patients received disorder specific guided self-help CBT for nine weeks. Non-responders were then randomised to face-to-face CBT or continued guided self-help. In Study IV predictors of outcome for guided self-help CBT in Study III were investigated. Results Study I showed that psychological interventions were more effective than care as usual in reducing sick leave and psychiatric symptoms but the effect sizes were small (g = 0.15 and 0.20, respectively). There was no significant difference in effect between work focused interventions, problem solving therapy, CBT or collaborative care. In Study II, there was no significant difference between treatments regarding days on sick leave one year after treatment start; CBT however led to larger reduction of symptoms post-treatment than RTW-I. In Study III, 40% of patients were in remission after nine weeks of guided self-help CBT. After Step II, 39% of the non-remitted patients who had been randomised to face-to-face CBT were in remission compared to 19% of patients who received continued guided self-help (p < 0.05). Study IV showed that patients across all disorders benefitted from guided self-help CBT, but those with social anxiety disorder and depression reached remission to a lower extent. Higher educational level predicted remission, higher quality of life ratings predicted remission and post treatment depression ratings, and higher age at onset predicted reliable change. All investigated therapy related variables, e.g., adherence to treatment and expectancy of outcome, were positively associated to outcome. Conclusions …

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APA (6th Edition):

Salomonsson, S. (2018). CBT in primary care : effects on symptoms and sick leave, implementation of stepped care and predictors of outcome . (Thesis). Karolinska Institute. Retrieved from http://hdl.handle.net/10616/46168

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Chicago Manual of Style (16th Edition):

Salomonsson, Sigrid. “CBT in primary care : effects on symptoms and sick leave, implementation of stepped care and predictors of outcome .” 2018. Thesis, Karolinska Institute. Accessed December 13, 2018. http://hdl.handle.net/10616/46168.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

MLA Handbook (7th Edition):

Salomonsson, Sigrid. “CBT in primary care : effects on symptoms and sick leave, implementation of stepped care and predictors of outcome .” 2018. Web. 13 Dec 2018.

Vancouver:

Salomonsson S. CBT in primary care : effects on symptoms and sick leave, implementation of stepped care and predictors of outcome . [Internet] [Thesis]. Karolinska Institute; 2018. [cited 2018 Dec 13]. Available from: http://hdl.handle.net/10616/46168.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Council of Science Editors:

Salomonsson S. CBT in primary care : effects on symptoms and sick leave, implementation of stepped care and predictors of outcome . [Thesis]. Karolinska Institute; 2018. Available from: http://hdl.handle.net/10616/46168

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

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