important not only to provide good healing conditions,
but also to work with prevention, in order to minimize
the risk of relapse. No articles were found exploring
interventions for prevention of relapse.
CONCLUSION
J. Wallensten et al.
340
There are few high-quality studies examining the ef-
fects of interventions on SED. Among patients with
stress-related conditions and adjustment disorder,
CBI and MMI appear to reduce symptoms, at least
until the end of the intervention. For SED, only WI,
either with work-focused CBT or workplace dialogue
intervention, seem to improve RTW. CBI and nature-
based rehabilitation do not appear to improve RTW.
Sleep appears to be important for both symptom
improvement and RTW, and interventions for impro-
ving sleep might therefore be important. Cognitive
impairment is a main complaint among patients with
SED, and probably contributes to the long-term sick
leave. For improvement of cognitive function aerobic
and cognitive training may have some effect. Research
on interventions for rehabilitation of SED show only
marginal effects. Thus, it is important to prevent the
onset of SED.
REFERENCES
1. European Union. Work-related stress. Dublin, Ireland:
European Foundation for the Improvement of Living and
Working Conditions; 2010. Availible from: https://www.
eurofound.europa.eu/publications/report/2010/work-
related-stress.
2. Lidwall U, Olsson-Bohlin C. [Psychiatric diagnoses. Short
analyses 2017: 1. Long way to work after sickleave.
sjukskrivning.] Prognos Afao; 2017.Report no.: ISBN
978-91-7500-398-6 FK-nr: 116–116.
3. Maslach C, Leiter MP. Understanding the burnout expe-
rience: recent research and its implications for psychiatry.
World Psychiatry 2016; 15: 103–111.
4. Maslach C, Jackson SE. The measurement of experienced
burnout. J Organiz Behav 1981; 2: 99–113.
5. Blix E, Perski A, Berglund H, Savic I. Long-term occupa-
tional stress is associated with regional reductions in brain
tissue volumes. PLoS One 2013; 8: e64065.
6. Savic I. Structural changes of the brain in relation to oc-
cupational stress. Cereb Cortex 2015; 25: 1554–1564.
7. Savic I, Perski A, Osika W. MRI shows that exhaustion
syndrome due to chronic occupational stress is associated
with partially reversible cerebral changes. Cereb Cortex
2018; 28: 894–906.
8. Wallensten J, Asberg M, Nygren A, Szulkin R, Wallen H,
Mobarrez F, et al. Possible Biomarkers of Chronic Stress
Induced Exhaustion - A Longitudinal Study. PloS one 2016;
11: e0153924.
9. Grossi G, Perski A, Osika W, Savic I. Stress-related exhaus-
tion disorder--clinical manifestation of burnout? A review of
assessment methods, sleep impairments, cognitive distur-
bances, and neuro-biological and physiological changes
in clinical burnout. Scand J Psychol 2015; 56: 626–636.
10. Sandstrom A, Rhodin IN, Lundberg M, Olsson T, Nyberg L.
Impaired cognitive performance in patients with chronic
burnout syndrome. Biol Psychol 2005; 69: 271–279.
11. Ekstedt M, Soderstrom M, Akerstedt T. Sleep physiology in
www.medicaljournals.se/jrm
recovery from burnout. Biol Psychol 2009; 82: 267–273.
12. Sandstrom A, Peterson J, Sandstrom E, Lundberg M, Ny-
strom IL, Nyberg L, et al. Cognitive deficits in relation to
personality type and hypothalamic-pituitary-adrenal (HPA)
axis dysfunction in women with stress-related exhaustion.
Scand J Psychol 2011; 52: 71–82.
13. Rydmark I, Wahlberg K, Ghatan PH, Modell S, Nygren Å,
Ingvar M, et al. Neuroendocrine, cognitive and structural
imaging characteristics of women on longterm sickleave
with job stress-induced depression. Biol Psychiatry 2006;
60: 867–873.
14. Wahlberg K, Ghatan PH, Modell S, Nygren Å, Ingvar M, Ås-
berg M, et al. Suppressed neuroendocrine stress response
in depressed women on job-stress-related long-term sick
leave: a stable marker potentially suggestive of preexisting
vulnerability. Biol Psychiatry 2009; 65: 742–747.
15. Harvey SB, Wessely S, Kuh D, Hotopf M. The relationship
between fatigue and psychiatric disorders: evidence for
the concept of neurasthenia. J Psychosom Res 2009; 66:
445–454.
16. Glise K, Ahlborg G Jr, Jonsdottir IH. Prevalence and course
of somatic symptoms in patients with stress-related ex-
haustion: does sex or age matter. BMC Psychiatry 2014;
14: 118.
17. Golkar A, Johansson E, Kasahara M, Osika W, Perski A,
Savic I. The influence of work-related chronic stress on
the regulation of emotion and on functional connectivity
in the brain. PLoS One 2014; 9: e104550.
18. Jovanovic H, Perski A, Berglund H, Savic I. Chronic stress
is linked to 5-HT(1A) receptor changes and functional
disintegration of the limbic networks. Neuroimage 2011;
55: 1178–1188.
19. Sandstrom A, Sall R, Peterson J, Salami A, Larsson A,
Olsson T, et al. Brain activation patterns in major depres-
sive disorder and work stress-related long-term sick leave
among Swedish females. Stress 2012; 15: 503–513.
20. Gavelin HM, Neely AS, Andersson M, Eskilsson T, Jarvholm
LS, Boraxbekk CJ. Neural activation in stress-related ex-
haustion: cross-sectional observations and interventional
effects. Psychiatry Res Neuroimaging 2017; 269: 17–25.
21. Schoenfeld TJ, Gould E. Stress, stress hormones, and adult
neurogenesis. Exp Neurol 2012; 233: 12–21.
22. Vyas A, Mitra R, Shankaranarayana Rao BS, Chattarji S.
Chronic stress induces contrasting patterns of dendritic
remodeling in hippocampal and amygdaloid neurons. J
Neurosci 2002; 22: 6810–6818.
23. Kim JJ, Diamond DM. The stressed hippocampus, synaptic
plasticity and lost memories. Nat Rev Neurosci 2002; 3:
453–462.
24. Jonsdottir IH, Nordlund A, Ellbin S, Ljung T, Glise K,
Wahrborg P, et al. Cognitive impairment in patients with
stress-related exhaustion. Stress 2013; 16: 181–190.
25. Eskildsen A, Andersen LP, Pedersen AD, Andersen JH. Cogni-
tive impairments in former patients with work-related stress
complaints – one year later. Stress 2016; 19: 559–566.
26. Glise K, Ahlborg G, Jr, Jonsdottir IH. Course of mental
symptoms in patients with stress-related exhaustion:
does sex or age make a difference? BMC Psychiatry 2012;
12: 18.
27. Miller GE, Chen E, Zhou ES. If it goes up, must it come
down? Chronic stress and the hypothalamic-pituitary-adre-
nocortical axis in humans. Psychol Bull 2007; 133: 25–45.
28. European P, Rehabilitation Medicine Bodies A. White Book
on Physical and Rehabilitation Medicine (PRM) in Europe.
Chapter 1. Definitions and concepts of PRM. Eur J Phys
Rehabil Med 2018; 54: 156–165.
29. Richardson KM, Rothstein HR. Effects of occupational stress
management intervention programs: a meta-analysis. J
Occup Health Psychol 2008; 13: 69–93.
30. van der Klink JJ, Blonk RW, Schene AH, van Dijk FJ. The
benefits of interventions for work-related stress. Am J
Public Health 2001; 91: 270–276.
31. Dalgaard VL, Andersen LPS, Andersen JH, Willert MV,