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A Novel Stress and Coping Workplace Program Reduces Illness and Healthcare Utilization

From the Nevada Stress Center (R.H.R., R.L.T.), VA Sierra Nevada Health Care System, Reno, NV; Department of Psychiatry (R.H.R.), Päijät-Häme Central Hospital, Lahti, Finland; Department of Psychiatry and Behavioral Sciences (C.B.T., S.B.), Stanford University School of Medicine, Stanford, CA; and Office of Medical Education (L.M.N., T.L.V.), University of Nevada School of Medicine, Reno, NV.

Address reprint requests to: Richard H. Rahe, MD, Nevada Stress Center, Code 151-C, VA Sierra Nevada Health Care System, 1000 Locust Street, Reno, NV 89502-2597. Email: rahe{at}equinox.unr.edu

OBJECTIVE: The purpose of this study was to determine if a novel workplace stress management program, delivered either face-to-face or by self-help, would reduce illness and health services utilization among participants.

METHODS: Five hundred one volunteers were randomly allocated to one of three groups: full intervention, which received assessment and personalized self-study feedback and was offered six face-to-face, small-group sessions; partial intervention, a self-help group that received assessment and personalized feedback by mail; and a wait-list control group. All participants completed questionnaires for stress, anxiety, and coping at the start of the study and 6 and 12 months later. Health reports were completed at 0, 3, 6, 9, and 12 months. A subsample of subjects who subscribed to a single health maintenance organization provided objectively recorded doctor visit data across the study year.

RESULTS: All three groups reported significant improvement in their stress, anxiety, and coping across the year. Full intervention participants showed a more rapid reduction in negative responses to stress than did participants from the other groups. Full-intervention subjects also reported fewer days of illness than subjects in the other groups. Objectively measured physician visits showed a large (34%) reduction in healthcare utilization for full intervention subjects in the HMO subsample.

CONCLUSIONS: These results indicated that a work-site program that focuses on stress, anxiety, and coping measurement along with small-group educational intervention can significantly reduce illness and healthcare utilization.

Key Words: stress, • coping, • stress management, • healthcare utilization, • illness reporting, • work site.

Abbreviations: ANOVA = analysis of variance;; HMO = health maintenance organization;; QHRQ = Quarterly Health Report Questionnaire;; ROC = relative operating curve;; SCI = Stress and Coping Inventory;; STAI = State-Trait Anxiety Inventory.