Reducing long term sickness absence by an activating intervention in adjustment disorders: a cluster randomised controlled design

Abstract

Aims:To compare an innovative activating intervention with "care as usual" (control group) for the guidance of employees on sickness leave because of an adjustment disorder. It was hypothesised that the intervention would be more effective than care as usual in lowering the intensity of symptoms, increasing psychological resources, and decreasing sickness leave duration. Methods: A prospective, cluster randomised controlled trial was carried out with 192 patients on first sickness leave for an adjustment disorder. Symptom intensity, sickness duration, and return to work rates were measured at 3 months and 12 months. Analyses were performed on an intention to treat basis. Results: At 3 months, significantly more patients in the intervention group had returned to work compared with the control group. At 12 months all patients had returned to work, but sickness leave was shorter in the intervention group than in the control group. The recurrence rate was lower in the intervention group. There were no differences between the two study groups with regard to the decrease of symptoms. At baseline, symptom intensity was higher in the patients than in a normal reference population, but decreased over time in a similar manner in both groups to approximately normal levels. Conclusion: The experimental intervention for adjustment disorders was successful in shortening sick leave duration, mainly by decreasing long term absenteeism. S ickness leave is generally considered as a major source of societal costs in Western countries. With the increase in mental workload of the past decades, the fraction of psychological problems related to occupational stress has increased rapidly. These problems are also reported in the literature as emotional distress or stress related disorders. For example, the United Nations International Labour Organisation 1 estimated the cost of work absence and loss of productivity at US$200 billion a year for the USA. Comparable figures have been reported for European countries. If emotional distress goes together with sickness leave, it concurs with the DSM IV classification "adjustment disorder".5 Although adjustment disorders can be considered as minor psychiatric morbidity, Schröer reported that at least 20% of patients with such a disorder do not return to work within a year, usually leading to loss of employment.6 Adjustment disorders account for most psychopathology giving rise to inability to work in the Netherlands, whereas psychiatric illnesses, such as major depression, anxiety disorders, psychoses, and personality disorders, account for only a small minority of cases.7 Indeed, in the Netherlands, 33% of disability benefit payments for chronic illness are for mental disorders. At present, more than 50% of these are stress related disorders such as adjustment disorders. Despite the high prevalence of disabling adjustment disorders, there has been relatively little research on treatment efficacy in the occupational health care setting, and thus an effective treatment strategy has yet to be dete...

Early and Late Return to Work After Sick Leave: Predictors in a Cohort of Sick-Listed Individuals with Common Mental Disorders

“…Duration and severity of health problems before becoming sick-listed also affects time to RTW [16]. Rehabilitation interventions aiming for symptom recovery do not always lead to restored work ability among sick-listed individuals with common mental disorders [18]. Rather, a number of individual and contextual factors seem to influence actual RTW.…”

Predicting the Effectiveness of Work-Focused CBT for Common Mental Disorders: The Influence of Baseline Self-Efficacy, Depression and Anxiety

“…To give more insight into the benefits of combining cognitive-behavioural and work-focused techniques [8,17], we conducted an earlier study in which we compared the effectiveness of two CBTbased psychotherapeutic interventions: treatment as usual consisting of R-CBT and W-CBT [9]. W-CBT consisted of R-CBT treatment plus a module focusing on work and RTW that was integrated in each session.…”

A Cognitive-Behavioral Therapy Program Utilizing Virtual Reality for the Treatment of Adjustment Disorders: A Case Series

“…Los TA constituyen un diagnóstico muy frecuente entre los clínicos (Despland, Monod y Ferrero 1995) y se consideran un importante problema de salud pública (Van der Klink, Blonk, Schene y van Dijk, 2003). Varios estudios indican un porcentaje de adultos en atención primaria que sufren TA del 5% al 21% (APA 2000;Despland et al, 1995).…”

“…Muy frecuentemente el malestar y el deterioro de la actividad asociada con este problema llevan a una disminución del rendimiento en el trabajo. Según Van der Klink et al (2003), el TA es el problema de salud mental que causa más frecuentemente baja por enfermedad en los Países Bajos, con una importancia mucho mayor que otros trastornos como la depresión, la ansiedad, las psicosis o los trastornos de personalidad.…”

“…Por otra parte, solamente 4 de 10 de estos estudios fueron publicados en prestigiosas revistas con ín-dice de impacto; dos de ellos son estudios de caso (Nardi, Lichenbert y Kaplan, 1994;Powell y McCone, 2004) y los otros dos incluyeron grupos experimentales (González-Jaimes y Turnbull-Plaza, 2003; Van der Klink et al, 2003). No obstante, como señalan Casey y Bailey (2011), no existe ningún protocolo específico para el tratamiento de los TA, y la mayoría de estudios sobre este tema, además, presentan importantes problemas metodológicos.…”