Fatigue as a transdiagnostic symptom dimension: Novel approaches to assessment and treatment in primary care

Research problem and specific questionsExhaustion disorder (ED, utmattningssyndrom) is one of the most common and costly mental disorders in Sweden, but the validity of ED is debated and there are no evidence-based treatments.

The core of ED - fatigue - is common across a range of disorders, associated with work-disability and excess mortality.

There is mounting evidence from international research supporting that fatigue should be conceptualized as a transdiagnostic symptom dimension rather than a diagnosis-specific pathology.

Cognitive behavioral therapy (CBT) is effective in reducing fatigue across a range of medical conditions by the same change mechanisms. This speaks for a transdiagnostic treatment approach.

The purpose of this project is to increase knowledge of fatigue as a transdiagnostic symptom in primary care patients and to evaluate the effect of a highly accessible transdiagnostic CBT for fatigue on symptom reduction and long-term work disability.

We also aim to investigate moderators and mediators of treatment effect and treatment cost-effectiveness.Data and method Consecutively recruited primary care patients (N=500) with fatigue (independent of primary diagnosis) will be included in a multicenter randomized clinical trial and receive internet-delivered transdiagnostic CBT adjunct to care as usual, or care as usual only.

Primary outcome will be change in fatigue severity (pre-post treatment). Secondary outcomes include self-rated symptoms, functional ability, and objective measures of cognitive impairment. Registry data will be used for analysis of healthcare consumption and sickness absence to the 1-year follow-up.

Societal relevance and utilization  Fatigue is associated with suffering, work-disability, and high societal costs.

This project can build solid evidence for an accessible, cost-effective treatment for fatigue with the potential to improve functional ability and prevent long-term sickness absence.

Results can contribute to development of guidelines for assessment and treatment of fatigue, evidence-based recommendations for sick-leave prescription, and more efficient use of healthcare resources.Plan for project realization:Patients will be recruited from at least 3 primary care centers in Stockholm, using existing infrasturctures for care.

The project group is a multidisciplinary team of researchers and clinicians from Karolinska Institutet, Stockholm University, and Amsterdam University Medical Center, Netherlands.