Preventing sickness absence among employees with common mental disorders or stress-related symptoms at work: a cluster randomised controlled trial of a problem-solving-based intervention conducted by the Occupational Health Services

Abstract

ObjectivesCommon mental disorders (CMDs) are among the main causes of sickness absence and can lead to suffering and high costs for individuals, employers and the society. The occupational health service (OHS) can offer work-directed interventions to support employers and employees. The aim of this study was to evaluate the effect on sickness absence and health of a work-directed intervention given by the OHS to employees with CMDs or stress-related symptoms.MethodsRandomisation was conducted at the OHS consultant level and each consultant was allocated into either giving a brief problem-solving intervention (PSI) or care as usual (CAU). The study group consisted of 100 employees with stress symptoms or CMDs. PSI was highly structured and used a participatory approach, involving both the employee and the employee’s manager. CAU was also work-directed but not based on the same theoretical concepts as PSI. Outcomes were assessed at baseline, at 6 and at 12 months. Primary outcome was registered sickness absence during the 1-year follow-up period. Among the secondary outcomes were self-registered sickness absence, return to work (RTW) and mental health.ResultsA statistical interaction for group × time was found on the primary outcome (p=0.033) and PSI had almost 15 days less sickness absence during follow-up compared with CAU. Concerning the secondary outcomes, PSI showed an earlier partial RTW and the mental health improved in both groups without significant group differences.ConclusionPSI was effective in reducing sickness absence which was the primary outcome in this study.

Cost-Effectiveness of a Problem-Solving Intervention Aimed to Prevent Sickness Absence among Employees with Common Mental Disorders or Occupational Stress

“…Figure 1 shows the recruitment of consultants, intervention and control groups ( Figure 1 is copied without changes from Keus van de Poll et al [ 8 ] under a CC BY 4.0 license). Randomization took place at the OHS consultant level using computer-generated random numbers randomizing OHS consultants into giving either PSI or CAU.…”

“…Ethical approval was obtained from the Ethical Review Board in Stockholm (registration number 2015/549-31/1). More details of the study design and procedures have been reported elsewhere [ 8 , 16 ].…”

“…These excluded costs due to production loss while at work (sensitivity analysis 1) and costs due to production loss while at work together with short-term sickness absence (sensitivity analysis 2). The reason for this was that employees in PSI returned to work sooner compared to employees in CAU [ 8 ]. This means that employees in PSI are “at work” for more days during the follow-up than employees in CAU and potentially have more hours of reduced production and more days of short-term sickness absence.…”

“…In Keus van de Poll et al [ 8 ], we compared a work-directed intervention based on problem-solving (PSI) with care as usual (CAU), both conducted by the occupational health service (OHS) for employees with CMD to prevent, or reduce, sickness absence and facilitate RTW. Long-term sickness absence was reduced with at least 15 days over a one-year follow-up, for employees that received PSI.…”

“…However, as work-directed interventions have shown to be effective in reducing sickness absence and promoting RTW [ 7 ], it might be that such interventions not only are more effective but also more cost-effective than CAU. Since the work-directed intervention studied by Keus van de Poll et al [ 8 ] showed to be effective in reducing sickness absence and promoting RTW, the aim of the current study was to investigate the cost-benefit and cost-effectiveness of this work-directed intervention from both an employer and a societal perspective.…”