title: Early identification in primary health care of people at risk for sick leave due to work-related stress - study protocol of a randomized controlled trial (RCT).
abstract: Early identification of persons at risk of sickness absence due to work-related stress is a crucial problem for society in general, and primary health care in particular. Tho date, no established method to do this exists. This project's aim is to evaluate whether systematic early identification of work-related stress can prevent sickness absence. This paper presents the study design, procedure and outcome measurements, as well as allocation and baseline characteristics of the study population.
  
  
  
  The study is a two-armed randomized controlled trial with follow-up at 3, 6 and 12 months. Non-sick-listed employed women and men, aged 18 to 64 years, who had mental and physical health complaints and sought care at primary health care centers (PHCC) were eligible to participate. At baseline work-related stress was measured by the Work Stress Questionnaire (WSQ), combined with feedback at consultation, at PHCC. The preventive intervention included early identification of work-related stress by the WSQ, GP training in the use of WSQ, GP feedback at consultation and finding suitable preventive measures. A process evaluation was used to explore how to facilitate future implementation and structural use of the WSQ at the PHCC. The primary outcome to compare the preventive sick leave intervention by the general practitioner (GP) versus treatment as usual is sick leave data obtained from the Swedish Social Insurance Agency register.
  
  
  
  Early screening for sick leave due to work-related stress makes it possible not only to identify those at risk for sick leave, but also to put focus on the patient's specific work-related stress problems, which can be helpful in finding suitable preventive measures. This study investigates if use of the WSQ by GPs at PHCCs, combined with feedback at consultation, prevents future sickness absence.
  
  
  
  ClinicalTrials.gov. Identifier: NCT02480855 . Registered 20 May 2015.
authors.affiliation: Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden. kristina.holmgren@neuro.gu.se.|Section for Epidemiology and Social Medicine, Institute of Medicine, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden. kristina.holmgren@neuro.gu.se.
authors.forename: Kristina
authors.identifier: 0000-0003-0061-5550
authors.initials: K
authors.lastname: Holmgren
authors.affiliation: Section for Epidemiology and Social Medicine, Institute of Medicine, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: Christine
authors.initials: C
authors.lastname: Sandheimer
authors.affiliation: The Sahlgrenska University Hospital, Gothenburg, Sweden.|, Novo Nordisk A/S, Box 50587, SE-202 15, Malmö, Sweden.
authors.forename: Ann-Charlotte
authors.initials: AC
authors.lastname: Mårdby
authors.affiliation: Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.|Närhälsan Research and Development, Primary Health Care, Region Västra Götaland, Sweden.
authors.forename: Maria E H
authors.initials: ME
authors.lastname: Larsson
authors.affiliation: Department of Health Sciences, Community and Occupational Medicine University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Ute
authors.initials: U
authors.lastname: Bültmann
authors.affiliation: The unit of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: Dominique
authors.initials: D
authors.lastname: Hange
authors.affiliation: Section for Epidemiology and Social Medicine, Institute of Medicine, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: Gunnel
authors.initials: G
authors.lastname: Hensing
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000453:epidemiology* / Q000523:psychology; D009786:Occupational Health Services; D017063:Outcome Assessment, Health Care; D018582:Sick Leave / Q000706:statistics & numerical data*; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D017132:Workplace; D055815:Young Adult
keywords: Intervention; Organizational climate; Psychosocial work factors; Work Stress Questionnaire (WSQ); Work commitment