Programme no. 358-P
Psychological distress; experiences and treatment in primary health care
1The Sahlgrenska Academy,Institute of Health and Care Sciences,Gothenburg,Sweden
* = Presenting author
Objectives: The overall objective of this thesis was to explore what it means to live with psychological distress and to evaluate and compare three 8-week interventions: integrative treatment (IT) compared to therapeutic acupuncture (TA) and conventional treatment (CT) in a pragmatic randomized controlled trial (RCT).
Background: Psychological distress is a major public health problem both in Sweden and internationally. Primary care provides the first level and often the only mental health care for psychological distress, yet its detection, diagnosis and treatment are inadequate in primary care settings. More knowledge is needed about the condition and its treatment.
Results: The comprehensive interpretation of the experiences of living with psychological distress was that an imbalance (incongruence) exists between the self and the ideal self which slowly breaks down a person's self-esteem. This imbalance is described in three dimensions: Struggling to cope with everyday life, Feeling inferior to others and Losing one’s grip on life. The three dimensions seem to lead to dissatisfaction, suffering, poor self-esteem and lack of control, which in turn may precede mental, physical and emotional exhaustion (I). In the RCT study, there were no significant differences on any variable at baseline (II-IV). Already after 4 weeks of treatment anxiety and depression improved significantly both statistically and clinically in IT and TA (II). At 8 weeks, IT and TA showed improvements on all variables (anxiety, depression, QoL and SOC) from baseline and in comparison with CT (II and III). At 6 months follow-up, improvements seen at 8 weeks in IT and TA remained, while CT showed a marginal improvement in anxiety (IV).
Material/Methods: Study participants consisted of outpatients 20-55 years who sought care for psychological distress such as anxiety, depression, sleep disturbances, fatigue, headache or somatic pain. The interviews (n=12) were analyzed with phenomenological hermeneutical method (I) and the treatments were evaluated in a RCT comprising 120 participants, using standardized self-reported questionnaires at baseline, after 4 and 8 weeks of treatment (II-III), as well as at follow-up 6 months later (IV). Primary outcome variables were anxiety and depression measured with the Hospital Anxiety and Depression Scale (HADS). Secondary variables were quality of life (QoL) measured with the Short Form-36 and sense of coherence (SOC).
Conclusion: This thesis has shown that psychologically distressed individuals have considerable difficulties in coping with daily life, yet usual care provided at primary care centers appears to be less effective in relieving symptoms of depression and anxiety and in improving QoL and SOC than a less conventional treatment combining therapeutic acupuncture with a person-centered approach with structured salutogenic dialogue.
Points for discussion: More research is needed to confirm the results.