Helping stress victims back to daily life

A quarter of Danes report high stress levels, and the number rises by approximately 1% per annum, according to a National Board of Health survey of 168,000 people.  Stress has serious consequences for individuals, the health system and the economy. It costs society billions every year in lost productivity, side effects, sick leave and early retirement.

Long-term stress puts a strain families, reduces quality of life and can lead to fatigue, heavy smoking and drinking, inactivity and obesity. It also exacerbates the risk of depression, sick leave, psychological problems at work, loss of earnings capacity, early retirement and even physical accidents in workplaces.

Due to all of the factors above, stress is also an increasing burden on the health service: In 2015, 94% of GPs registered increases in the number of patients asking for stress-related sick leave. Three out of four doctors lamented the lack of stress programmes to which they could refer patients.
Only three out of ten local authorities run stress programmes. Some offer programmes run by volunteers, and few run anything based on research. They not only lack the resources to cope with the problem, but also knowledge about which treatments work, for which types of people and why.

The Open and Calm programme

Since 2009, the health psychologist and researcher Christian Gaden Jensen has been developing a research-based programme of treatment for stress and inviting local authorities to adopt the method.
In 2011, with funding from the Nordea Foundation, and working with 20 general practices in Copenhagen, he launched the research project Open and Calm at a brain research centre in Copenhagen University Hospital. The practices referred stressed patients to the unit. The effectiveness of the research-based stress programme has now been tested at a number of local authority stress clinics in Copenhagen and Aalborg that treat thousands of people every year.

Stress and poor mental health cost Denmark over DKK 10 billion every year. But lack of funds at local authority level means that the provisions to prevent mental illness and treat stress are a bit hit or miss. Neither the initial referrals, i.e. who is offered which treatment, nor the efficacy of the individual treatments are knowledge-based. Open and Calm is one of the first research-based programmes to be offered by local authorities. We work with universities and the councils, systematically evaluating the programme to ensure that it leads to significant and lasting changes for the individuals referred to it.

The target group consists of women and men aged 18+ with symptoms of stress like fatigue, difficulty sleeping, pain, sadness or worry, all of which may be triggered by a range of factors, including a poor social environment at work, prolonged illness or family pressures. The participants range from 18-year-old students to parents with small children, middle-aged people and pensioners. Approximately half of them think that work is the main cause of their stress. The rest identify other factors, including unemployment.

The closer attention paid to young people’s mental health in recent years has led Jensen to work with partners like the Danish University of Education and Aarhus University on programmes to target stress in young people and students.

Open and Calm is based on 40 years of international research into stress, health promotion and meditation. The nine-week programme is aimed at people with physical, psychological and social symptoms, and includes physical exercise, meditation and therapy, with the focus on mental well-being. An app and a website provide support in the form of exercises and advice.

Outcomes

City of Copenhagen: Many of those on sick leave recovered and returned to work after the programme

• 58% of those on sick leave went back to work
• 38% of those on sick leave and unemployed found a job
• 63% said that it helped improve their life at work
• 27% said that it helped them keep their jobs
• 88% said that it made it easier for them to cope with stressful situations
• Only 8% experienced adverse effects.

The City of Copenhagen concluded that:

“a significant number of people transitioned from sick leave and unemployment to proper full-time employment after the programme”.

The effect of Open and Calm has been thoroughly documented in a randomised controlled trial, 14 evaluation reports and qualitative studies of the results. Several studies from the clinics show long-term effects of the programme up to a year after it ended.

Evaluations show that the participants experienced major positive effects in both the short and long term. For example:

• They reported significant improvements in well-being and health, including lower levels of stress and depression and better sleep
• Their physical responses reveal lower levels of the stress hormone cortisol
• The effects are equally positive regardless of sex and age
• Those who had the highest levels of stress and depression at the start of the programme made the greatest improvements
• The programme prepares people for work – going back to work as well as keeping their jobs
• The participants were highly positive about the programme.

The programme has 100% changed how I live. I use the tools that I learned every day. I work in a different sector now. I am more calm and have mental and physical energy to spare in my day-to-day life. I almost never suffer anxiety anymore. Attending the programme was the best decision I’ve made. Thank you very much for the help!

Open and Calm seems to have a positive impact on the participants’ employment rates (see graph).

Further research

The researchers’ work on the Open and Calm programmes in the two local authorities has generated a great deal of new knowledge about the treatment of stress. They are now developing a new programme and documenting the effects.

Mariagerfjord Council now also offers treatment based on the Open and Calm programme. Christian Gaden Jensen started work with TopDanmark Insurance on a one-year project in 2018. The company refers customers to the programme at the University’s Centre for Mental Health Promotion. Many Danes are entitled to stress treatment though their health insurance. The knowledge generated by this project will be incorporated into the general research conducted into stress.

The researchers now want to conduct large-scale scientific trials to document the long-term social and health-economic effects of the Open and Calm programme.

The stress-treatment programme Open and Calm now involves:

• Five local authority stress clinics (Copenhagen, Aalborg, Mariagerfjord, Skanderborg, Odense)
• The TopDanmark insurance company
• More than 800 doctors, who refer patients to the clinics
• Around 2,600 people who suffer from stress.

Open and Calm is free.

The annual costs of psychologically stressful working environments in Denmark:

• DKK 3.4 billion in lost productivity
• 670,000 days of short-term sick leave
• 350,000 days of long-term sick leave
• 170 cases of early retirement.

(Source: the Danish Health Authority, 2016).

Media coverage and publications

“Research into how insurance companies deal with stress”. Politiken, January 2018

“Clinics to help stress sufferers to a better life”. Berlingske, May 2015

“Calm revolution”. P: The Psychologists’ Magazine, January 2015