Effectiveness of a Coordinated and Tailored Return-to-Work Intervention for Sickness Absence Beneficiaries with Mental Health Problems (original) (raw)
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Scandinavian Journal of Work, Environment and Health, 2016
Objectives Both the presence of mental health problems and the absence of an employment contract have been related to long-term sickness absence and unemployment, indicating a need for return to work (RTW) interventions. Our aim was to study the effectiveness of a new participatory supportive RTW program for workers without an employment contract, sick-listed 2-14 weeks due to a common mental disorder, in comparison with usual care. Methods A participatory approach, integrated care and direct placement in a competitive job were part of the new program. The primary outcome measure was duration until first sustainable RTW in competitive employment. Cox regression analysis was applied to study this outcome. Secondary outcome measures were average working hours, duration until any type of employment, sickness benefit duration, and perceived health and functioning. Results In total, 186 participants were included in the study and randomly allocated to an intervention group (N=94) or control group (N=92). A hazard ratio of 1.15 (95% CI 0.61-2.16) for duration until first sustainable RTW indicated no significant effect of allocation to the new program, compared to usual care. Furthermore, no significant differences were found in favor of the intervention group on any secondary outcome. Conclusions Compared to usual care, the new program did not result in a significant shorter duration until first sustainable RTW. However, due to low protocol adherence, it remains unclear what the results would have been if the program had been executed according to protocol.
Disability and Rehabilitation, 2012
To identify health-, personal-and work-related factors predictive of return to work (RTW) in employees sick-listed due to common mental health problems, such as, stress, depression, burnout, and anxiety. Methods: We distributed a baseline questionnaire to employees applying for sickness absence benefits at a large Danish welfare Department (n = 721). A total of 298 employees returned the questionnaire containing information on possible predictors of RTW. We followed up all baseline responders for a maximum of one year in a national registry of social transfer payments, including sickness absence benefits. Results: At baseline, about 9% of respondents had quit their job, 10% were dismissed and the remaining 82% were still working for the same employer. The mean time to RTW, measured from the first day of absence, was 25 weeks (median = 21) and at the end of follow-up (52 weeks) 85% had returned to work. In the fitted Cox model we found that fulfilling the DSM-IV criteria for depression predicted a longer time to RTW (HR: 0.61, CI: 0.45-0.84), whereas a better self-rated health predicted a shorter time to RTW (HR: 1.18, CI: 1.03-1.34). Employees working in the municipal (HR: 0.62, CI: 0.41-0.94) and private sector (HR: 0.65, CI: 0.44-0.96) returned to work slower compared to employees working in the governmental sector. Gender, education, cohabitation, size of workplace, lowback and upper-neck pain and employment at baseline did not predict RTW. Conclusion: Our results indicate that time to RTW is determined by both health-and work-related factors.
Occupational and Environmental Medicine, 2013
General introduction | Chapter 1 13 process. The SHARP-at work intervention is provided by OPs to align with the Dutch OP guideline on the management of mental health problems of workers, and because OPs are closely connected to the work environment. OPs guide workers through the fivestep problem solving process to find and implement solutions for problems/ opportunities experienced when back at work. OPs monitor that all steps are taken and activate and support the worker when needed. Furthermore, OPs empower the worker to define the problems and design solutions. Two to five consultations are recommended to the OPs, and assignments are available for each step of the intervention. The first assignment is the key element of the intervention. In this assignment, workers have to make an inventory of problems and opportunities at work and, subsequently, to define if help is needed to solve the problems or realise the opportunities. THESIS OBJECTIVE AND RESEARCH QUESTIONS The objective of this thesis is to generate knowledge on the prevention of recurrent sickness absence in workers who returned to work after sickness absence due to CMDs. The main focus is on the evaluation of the effectiveness of the SHARP-at work intervention in preventing recurrent sickness absence in workers who returned to work after sickness absence due to CMD. Alongside this effect evaluation, a process evaluation and an economic evaluation are presented. The process evaluation is helpful in explaining the results of the effect evaluation and whether these results are attributable to the SHARP-at work intervention. As part of the process evaluation, an indepth exploration of challenges with recruiting research participants by OPs is described. The economic evaluation provides information on the cost-effectiveness and cost-benefit of the intervention. Next to the evaluation of the SHARP-at work intervention, a systematic literature review is presented on interventions to facilitate return to work in adults with adjustment disorders. A specific focus on adjustment disorders as a subgroup of CMDs is chosen as this group has often been investigated in relation to RTW. Also, predictors for recurrent sickness absence among workers with CMDs are investigated. The following research questions form the basis of this thesis: Research question 1: Which interventions are effective in facilitating return to work in workers with adjustment disorders? Research question 2: Is the SHARP-at work intervention effective in preventing recurrent sickness absence and improving mental health, work functioning and problem solving coping in workers who returned to work after sickness absence due to CMDs compared to care as usual? Chapter 1 | General introduction 14 Research question 3: Is the SHARP-at work intervention conducted according to the protocol, does it differ from care as usual, and how are the key elements of the intervention related to the effect outcome (i.e. recurrent sickness absence)? Research question 4: What are barriers and facilitators for participant recruitment by occupational physicians? Research question 5: Is the SHARP-at work intervention cost-effective and costbeneficial compared to care as usual? Research question 6: Which factors predict recurrent sickness absence in workers who returned to work after sickness absence due to CMDs? THESIS OUTLINE This first chapter provides an overall introduction to the topic of the thesis to address the importance of the topic, explain the context and describe relevant constructs. In Chapter 2, the results of a systematic literature review are presented on the effectiveness of interventions to enhance return to work in workers with adjustment disorders. Chapter 3 describes the study design of the cluster-RCT with an effect evaluation, process evaluation and economic evaluation of the SHARP-at work intervention compared to care as usual. Chapter 4 presents the effect of the SHARP-at work intervention on preventing recurrent sickness absence in workers who returned to work after sickness absence due to CMDs. Moreover, the effects on mental health complaints, work functioning and coping behaviour are evaluated. In Chapter 5, the process evaluation of the SHARP-at work intervention is described. The chapter focuses on: 1) evaluating whether the SHARP-at work intervention was conducted according to the protocol and differed from care as usual, and 2) investigating the relationship between the key elements of the intervention and the primary outcome of the effect evaluation (i.e. recurrent sickness absence). Chapter 6 focuses on problems with participant recruitment by OPs. Barriers and facilitators for recruitment as experienced by OPs are reported, and the relationship between OP's personal and work characteristics and the recruitment of participants is evaluated. Chapter 7 addresses the economic evaluation of the SHARP-at work intervention and presents the costeffectiveness and cost-benefit evaluations. In Chapter 8, predictors for recurrent sickness absence in workers who returned to work after sickness absence due to CMDs are investigated. In Chapter 9, a general discussion is provided. The main research results are summarized and discussed, methodological considerations are addressed and the implications of this thesis for future research and practice are presented. 16 23. van der Klink JJ, Blonk RW, Schene AH, van Dijk FJ. Reducing long term sickness absence by an activating intervention in adjustment disorders: A cluster randomised controlled design.
Employees Sick-Listed with Mental Disorders: Who Returns to Work and When?
Journal of Occupational Rehabilitation, 2012
Purpose To investigate return to work (RTW) in employees sick-listed with mental disorders classified according to the International Classification of Diseases (ICD). Methods Sickness absences (SA) medically certified as emotional disturbance (ICD-10 R45) or mental and behavioral disorders (ICD-10 F00-F99) were retrieved from an occupational health service register. RTW was associated with age, gender, and socioeconomic position (SEP) by parametric survival analysis. Results Emotional, neurotic, somatoform, stress-related, and mood disorders encompassed 94 % of all mental SA. Employees with emotional disturbance had the highest RTW rates: after 1 year 95 % had resumed work and after 2 years 98 % compared to 89 and 96 % of employees with neurotic, somatoform and stress-related disorders, and 70 and 86 % of employees with mood disorders. The probability of RTW decreased after 1 month of SA due to emotional disturbance, 2 months of SA with neurotic, somatoform and stress-related disorders, and 3 months of SA with mood disorders. Women resumed their work later than men. Young employees presenting with emotional disturbance, neurotic, somatoform, and stress-related disorders had earlier RTW than older employees and low-SEP employees had earlier RTW than high-SEP employees.
BMC Public Health, 2010
Background: Common mental disorders, such as depression, anxiety disorder, and adjustment disorder, have emerged as a major public and occupational health problem in many countries. These disorders can have severe consequences such as absenteeism and work disability. Different interventions have been developed to improve the return-to-work of employees with common mental disorders, but still a large proportion of employees experiences health and work problems after their return-to-work. For this reason, the SHARP-at work intervention is developed to prevent a relapse of sickness absence among employees who have returned to work after a period of sickness absence because of common mental disorders. We aim to evaluate the effectiveness, cost-benefit and process of the intervention compared to care as usual.
The European Journal of Public Health, 2011
Background: Sickness absence due to mental health problems (MHPs) is increasing in several European countries. However, little is known about return to work (RTW) for employees with MHPs. This prospective study aimed to identify predictors for RTW in employees sick-listed with MHPs. Methods: Employees were recruited when applying for sickness benefit due to MHPs from the Municipality of Copenhagen (n = 644). Information about age, gender, occupation, self-reported RTW expectancy, self-reported reason for absence and prior absence with MHPs was retrieved from application forms for sickness benefit. Each participant was followed-up in the National Register for Social Transfer Payments for a maximum period of 52 weeks to estimate time to RTW. Hazard ratios for RTW with 95% confidence intervals were calculated using Cox proportional regression analyses. Results: Employees sick-listed with self-reported stress/burnout returned to work faster than those with self-reported depression (HR = 0.76), and other MHPs (HR = 0.56). A positive RTW expectancy of the sick-listed person (HR = 1.27) and no prior absence with MHPs (HR = 1.29) were associated with a shorter time to RTW. Conclusion: Sickness absence due to self-reported stress/burnout, a positive RTW expectancy and no prior absence with MHPs predicted a shorter time to RTW among Danish employees sick listed with MHPs. Findings could help social insurance officers and other rehabilitation professionals to identify groups at high risk for prolonged absence.
Journal of Occupational Rehabilitation
Purpose Although common mental disorders (CMDs) highly impact individuals and society, a knowledge gap exists on how sickness absence can be prevented in workers with CMDs. This study explores: (1) workers’ perceived causes of sickness absence; (2) perceived return to work (RTW) barriers and facilitators; and (3) differences between workers with short, medium and long-term sickness absence. Methods A longitudinal qualitative study was conducted involving 34 workers with CMDs. Semi-structured interviews were held at two time-points during their RTW process. The 68 interviews were audio-taped, transcribed and thematically analyzed to explore workers’ perspective on sickness absence causes, RTW barriers and facilitators, and compare data across the three sub-groups of workers. Results Workers reported various causes for their absence, including: (1) high work pressure; (2) poor work relationships; (3) unhelpful thoughts and feelings, e.g. lacking self-insight; and (4) ineffective copin...
European journal of public health, 2016
Mental disorders are increasing and account for one-third of all disability benefits in OECD countries. This study investigated the work status after mental sickness absence (SA). Five-year longitudinal cohort study of 6678 male production workers. Work status, work schedule and work hours/week were retrieved from employer records in five years following RTW from mental SA. Longitudinal analysis was done with linear and logistic generalized estimating equations estimating relative risks (RRs) and odds ratios (ORs), respectively, controlled for age, marital status and occupational grade. In total, 4613 (69%) workers had complete data and were included in the analyses; 552 of them had experienced mental SA. In the years following mental SA, 102 (18%) workers left employment compared to 384 (9%) workers without mental SA. In the first year after mental SA, workers left employment at their own request and in later years they were dismissed because of poor work functioning. After mental ...
BMC Public Health, 2017
Background: Common mental disorders (CMDs) are among the leading causes of sick leave in Sweden and other OECD countries. They result in suffering for the individual and considerable financial costs for the employer and for society at large. The occupational health service (OHS) can offer interventions in which both the individual and the work situation are taken into account. The aim of this paper is to describe the design of a study evaluating the effectiveness of an intervention given at the OHS to employees with CMDs or stress-related symptoms at work. In addition, intervention fidelity and its relation to the outcome will be assessed in a process analysis. Methods: The study is designed as a cluster randomized trial in which the participating OHS consultants are randomized into either delivering the intervention or performing care as usual. Employees with CMDs or stress-related symptoms at work are recruited consecutively by the OHS consultants. The intervention aims to improve the match between the employee and the job situation. Interviews are held individually with the employee and the nearest supervisor, after which a joint meeting with both the employee and the supervisor takes place. A participatory approach is applied by which the supervisor and the employee are guided by the OHS consultant and encouraged to actively take part in problem solving concerning the work situation. Outcomes will be assessed at baseline and at six and 12 months. A long-term follow-up at 3 years will also be performed. The primary outcome is registered sickness absence during a 1-year period after study inclusion. Secondary outcomes are mental health and work ability. The intervention's cost effectiveness, compared to treatment as usual, both for society and for the employer will be evaluated. A process evaluation by both the OHS consultants and the employee will be carried out.