• Stress-related conditions. Elk Grove Village (IL): American College of Occupational and Environmental Medicine (ACOEM); 2004. 27 p. [129 references]

This is the current release of the guideline.

This guideline updates a previous version: Harris, J, ed. Occupational Medicine Practice Guidelines: American College of Occupational and Environmental Medicine. Beverly Farms, MA: OEM Press; 1997.

General Approach and Basic Principles (refer to the original guideline document for more detailed information)

Stressors may be any life event or circumstance that exerts a physical, emotional, or cognitive demand on the individual. The lifetime prevalence of major stressful life events is 100%, so associated stress-related symptoms may be considered a normal condition of human existence.

• Stress is not a diagnosis, disease, or syndrome. It is a nonspecific set of emotions or physical symptoms that may or may not be associated with a disease or syndrome. Whether or not stress contributes to a disease or syndrome depends on the vulnerability of the individual; the intensity, duration, and meaning of the stress; and the nature and availability of modifying resources.
• The initial assessment of patients with acute stress-related conditions focuses on detecting potentially serious psychopathology, or red flag conditions, requiring urgent specialty referral. The majority of patients with stress-related conditions will not have red flags and can be safely and effectively managed by occupational or primary care physicians.
• Relief of stress depends on its precipitants, which are often multifactorial. Psychosocial, workplace, or socioeconomic issues can be explored with the patient to facilitate early identification of precipitating factors and appropriate interventions that may prevent delayed recovery or relapse. An open, honest discussion of the underlying factors often results in an increase in the patient's insight and coping skills, which itself helps alleviate many stress-related symptoms.
• Worksite interventions may be helpful in mitigating or eliminating inciting stressors, depending on the source of the complaints.
• Medications generally have a limited role. Limit use of anti-anxiety agents to short periods of time (i.e., periods when overwhelming anxiety limits the patient's ability to work or effectively perform the activities of daily living). Antidepressant or antipsychotic medication may be prescribed for major depression or psychosis; however, this is best done in conjunction with specialty referral.
• Patients are encouraged to enhance their individual coping skills and to decrease or discontinue maladaptive coping mechanisms such as excessive use of alcohol, tobacco, or other drugs, or excessive food intake. Patients are counseled to redirect their energy to regular aerobic exercise, relaxation techniques, and cognitive coping mechanisms.
• For uncomplicated cases, absence from work should not exceed one work week. Referral for mental health professional assessment may be considered for patients whose anticipated absence from work will exceed one week.
• If symptoms become disabling despite primary care interventions or persist beyond three months, referral to a mental health professional is indicated.

None provided

The type of supporting evidence is not specifically stated for each recommendation.

• Stress-related conditions. Elk Grove Village (IL): American College of Occupational and Environmental Medicine (ACOEM); 2004. 27 p. [129 references]

Not applicable: The guideline was not adapted from another source.

1997 (revised 2004)

American College of Occupational and Environmental Medicine - Medical Specialty Society

American College of Occupational and Environmental Medicine

American College of Occupational and Environmental Medicine Practice Guidelines Committee

Chapter Lead: Lee S. Glass, MD

Committee Members: Jennifer H. Christian, MD, MPH, FACPM; Philip I. Harber, MD, MPH, FACOEM, FCCP; John P. Holland, MD, MPH, FACOEM; Kathryn L. Mueller, MD, MPH, FACEP, FACOEM; Douglas J. Patron, MD, MSPH; Bernyce M. Peplowski, DO, MS; and Jack Richman, MD, CCFP, DOHS, FACOEM

Timothy J. Key, MD, MPH, FACOEM, as Responsible Officer and ACOEM President Elect, and Edward A. Emmett, MD, MS, FACOEM, Chair of the ACOEM Council on Occupational and Environmental Medical Practice, contributed to the development of the guidelines as well.

Not stated

This is the current release of the guideline.

This guideline updates a previous version: Harris, J, ed. Occupational Medicine Practice Guidelines: American College of Occupational and Environmental Medicine. Beverly Farms, MA: OEM Press; 1997.

None available

None available

This NGC summary was completed by ECRI on May 31, 2006. The information was verified by the guideline developer on November 3, 2006. This summary was updated by ECRI Institute on November 9, 2007, following the U.S. Food and Drug Administration advisory on Antidepressant drugs.

The American College of Occupational and Environmental Medicine, the signator of this license, represent and warrant that they are the publisher of the guidelines and/or possess all rights necessary to grant the license rights to AHRQ and its agents.