Chronic Stress: National collaboration for evidence-based care

Stress-related disorders are amongst the leading causes of sick-leave in several countries. Still, there is little consensus on how chronic stress should be diagnosed, measured, and treated.

Exhaustion disorder (ED) is a diagnosis in the Swedish ICD-10 system and is, similar to the construct of clinical burnout, characterized by fatigue, cognitive dysfunction, and somatoform complaints.

In Sweden, ED accounts for more long-term sick leave than any other illness, and its prevalence in primary care is on par with major depressive disorder.

Importantly, the reliability and validity of the ED diagnosis has limited scientific support, and it has not been incorporated into the ICD-11 or the DSM-5.Even though cognitive behavioral therapy has shown to be effective in reducing stress in working populations, studies on clinical patients, including ED, are few and results are mixed.

Consequently, there is a lack of evidence-based treatment for ED. Given the severity, prevalence, and cost of ED, we aim to identify relevant outcomes to develop treatments.

We aim to do this by (1) conducting a literature review to assess validity and reliability of the ED diagnosis and identify knowledge gaps; (2) identifying outcomes of core importance to patients with ED through a survey for targeting their symptoms and treatment expectations; (3) establishing a nationwide collaboration of multidisciplinary researchers collating expertise to lay a foundation for a large multisite clinical trial.