Symptoms that may be stress-related and lead to exhaustion disorder: a retrospective medical chart review in Swedish primary care

BACKGROUND: Mental illness, and particularly stress-related disorders such as exhaustion disorder, is continuously increasing in today’s society. It is important to identify patients who consult for potentially stress-related symptoms early, before the stress condition develops into an exhaustion disorder. The purpose of the study was to investigate the frequency of different presenting complaints for which patients had consulted in the two years preceding receipt of their exhaustion disorder diagnosis, and to explore potential associations between stress-related presenting complaints and demographic factors, as well as comorbidity and other potentially stress-inducing factors. METHODS: This was a retrospective medical chart review of presenting complaints of adult patients with exhaustion disorder two years preceding receipt of diagnosis at a primary healthcare centre in western Sweden. RESULTS: Exhaustion disorder was diagnosed in 126 patients at the healthcare centre during the study period. Charts were available for 115 patients (76% women, mean age 47 years). Charts were reviewed with regard to presenting complaints, demographic data and comorbidity. Average number of general practitioner visits during the two years preceding the diagnosis was 5.2 (SD 3.7). The two most common complaints were infection and anxiety/depression, presented by 49% and 46%, respectively. Other stress-related complaints seen to in more than 30% of the patients were stress, other pain, fatigue, gastrointestinal symptoms, and sleep disturbances. Back pain and fatigue were more frequent in patients over 40 years. A majority of the patients also had mental (53%) or somatic (61%) comorbidity. Comorbidity was more frequent in older patients. No significant gender differences were found. CONCLUSIONS: Patients with exhaustion disorder appear to consult their general practitioner numerous times with stress-related complaints in the years preceding their diagnosis. The findings indicate which presenting complaints general practitioners may need to be more attentive to so that patients at risk of developing exhaustion disorder can be identified earlier and get the support they need. Addressing stress factors earlier in the course of illness and preventing the development of exhaustion disorder may contribute to a reduced burden for both individual patients and for society, with a reduction in sick leave and societal costs for mental illness.