Abstract 17347: What is the Impact of Psychobehavioral and Stress Management Interventions on Vital Exhaustion? A Meta-Analysis

Abstract

BACKGROUND: As a predictor of coronary heart disease and adverse cardiac events, vital exhaustion is characterized by unusual or excessive fatigue, with prevalence reported in cardiac and community populations. To our knowledge, the effects of psychobehavioral and stress management interventions on vital exhaustion have not been systematically evaluated in the literature. OBJECTIVE: To calculate quantitative estimates of the effect of psychobehavioral and stress management interventions on vital exhaustion.

METHODS: Published English language randomized and non-randomized interventional studies assessing vital exhaustion measured by Maastricht Questionnaire or Maastricht Interview for Vital Exhaustion were searched in the PubMed, PsychINFO, Web of Science, and CINAHL databases from January 1995 to May 2012. Data on study quality, sample characteristics, and outcomes were extracted and analyzed. Cohen’s d effect sizes were computed pre- to post-intervention for within-treatment group. RESULTS: Seven trials met inclusion criteria with 1,467 individuals (742 intervention/ 725 controls). Pooled effect estimate on vital exhaustion was 0.74 (95% Confidence Interval 0.43 - 1.06, p < 0.001) using random effects with DerSimonian-Laird modeling, indicating a highly significant moderate positive effect of lower vital exhaustion scores with psychobehavioral and stress management. Heterogeneity (Q = 40.685, p < 0.001) and inconsistency (I-squared = 85.3%) were observed. Univariate meta-regression with permutation methods showed no relationships with study or sample characteristics that could explain the heterogeneity in treatment effect. Contour-enhanced funnel plot suggests publication bias. CONCLUSION: Treatment with psychobehavioral and stress management improves vital exhaustion; this data may be limited by potential publication bias. These findings have implications for management of vital exhaustion among at-risk individuals.