Journal of Occupational Rehabilitation

, Volume 23, Issue 4, pp 621–630 | Cite as

Effectiveness of a Coordinated and Tailored Return-to-Work Intervention for Sickness Absence Beneficiaries with Mental Health Problems

  • Marie H. T. Martin
  • Maj Britt D. Nielsen
  • Ida E. H. Madsen
  • Signe M. A. Petersen
  • Theis Lange
  • Reiner Rugulies
Article

Abstract

Purpose Sickness absence and exclusion from the labour market due to mental health problems (MHPs) is a growing concern in many countries. Knowledge about effective return-to-work (RTW) intervention models is still limited, but a multidisciplinary, coordinated and tailored approach has shown promising results in the context of musculoskeletal disorders. The purpose of this study was to assess the effectiveness of this approach as implemented among sickness absence beneficiaries with MHPs. Methods In a quasi-randomised, controlled trial, we assessed the intervention’s effect in terms of time to RTW and labour market status after 1 year. We used two different analytical strategies to compare time to RTW between participants receiving the intervention (n = 88) and those receiving conventional case management (n = 80): (1) a traditional multivariable regression analysis controlling for measured confounding, and (2) an instrumental variable (IV) analysis controlling for unmeasured confounding. Results The two analytical approaches provided similar results in terms of a longer time to RTW among recipients of the intervention (HR = 0.50; 95 % CI 0.34–0.75), although the estimate provided by the IV-analysis was non-significant (HR = 0.70; 95 % CI 0.23–2.12). After 1 year, more recipients of the intervention than of conventional case management were receiving sickness absence benefits (p = 0.031). Conclusion The intervention delayed RTW compared to conventional case management, after accounting for measured confounding. The delayed RTW may be due to either implementation or program failure, or both. It may also reflect the complexity of retaining employees with mental health problems in the workplace.

Keywords

Return to work Sickness absence Mental health Intervention effectiveness 

References

  1. 1.
    OECD. Sickness, disability and work: breaking the barriers. A synthesis of findings across OECD countries. Paris: OECD Publishing; 2010.Google Scholar
  2. 2.
    van der Klink JJL, Blonk RWB, Schene AH, van Dijk FJH. Reducing long term sickness absence by an activating intervention in adjustment disorders: a cluster randomised controlled design. Occup Environ Med. 2003;60:429–37.PubMedCrossRefGoogle Scholar
  3. 3.
    Brouwers EPM, Tiemens BG, Terluin B, Verhaak PFM. Effectiveness of an intervention to reduce sickness absence in patients with emotional distress or minor mental disorders: a randomized controlled effectiveness trial. Gen Hosp Psychiatry. 2006;28:223–9.PubMedCrossRefGoogle Scholar
  4. 4.
    de Vente W, Kamphuis JH, Ernmelkamp PMG, Blonk RWB. Individual and group cognitive-behavioral treatment for work-related stress complaints and sickness absence: a randomized controlled trial. J Occup Health Psychol. 2008;13:214–31.PubMedCrossRefGoogle Scholar
  5. 5.
    Willert MV, Thulstrup AM, Bonde JP. Effects of a stress management intervention on absenteeism and return to work—results from a randomized wait-list controlled trial. Scand J Work Env Health. 2011;37:186–95.CrossRefGoogle Scholar
  6. 6.
    van Oostrom SH, van Mechelen W, Terluin B, de Vet HC, Knol DL, Anema JR. A workplace intervention for sick-listed employees with distress: results of a randomised controlled trial. Occup Environ Med. 2010;67:596–602.PubMedCrossRefGoogle Scholar
  7. 7.
    Fleten N, Johnsen R. Reducing sick leave by minimal postal intervention: a randomised, controlled intervention study. Occup Environ Med. 2006;63:676–82.PubMedCrossRefGoogle Scholar
  8. 8.
    Netterstrøm B, Bech P. Effect of a multidisciplinary stress treatment programme on the return to work rate for persons with work-related stress. A non-randomized controlled study from a stress clinic. BMC Public Health. 2010;10:658.PubMedCrossRefGoogle Scholar
  9. 9.
    Søgaard HJ, Bech P. The effect on length of sickness absence by recognition of undetected psychiatric disorder in long-term sickness absence. A randomized controlled trial. Scand J Public Health. 2009;37:864–71.PubMedCrossRefGoogle Scholar
  10. 10.
    Nieuwenhuijsen K, Bültmann U, Neumeyer-Gromen A, Verhoeven AC, Verbeek JH, van der Feltz-Cornelis CM. Interventions to improve occupational health in depressed people. Cochr Database System Rev. 2008;2:CD006237.Google Scholar
  11. 11.
    Borg V, Nexø M, Kolte I, Andersen M. Hvidbog om mentalt helbred, sygefravær og tilbagevenden til arbejde [White paper on mental health, sickness absence and return to work] [Danish]. Copenhagen: The National Research Centre for the Working Environment; 2010.Google Scholar
  12. 12.
    Bültmann U, Sherson D, Olsen J, Hansen CL, Lund T, Kilsgaard J. Coordinated and tailored work rehabilitation: a randomized controlled trial with economic evaluation undertaken with workers on sick leave due to musculoskeletal disorders. J Occup Rehabil. 2009;19:81–93.PubMedCrossRefGoogle Scholar
  13. 13.
    Bonell CP, Hargreaves J, Cousens S, Ross D, Hayes R, Petticrew M, et al. Alternatives to randomisation in the evaluation of public health interventions: design challenges and solutions. J Epidemiol Community Health. 2011;65:582–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Earle CC, Tsai JS, Gelber RD, Weinstein MC, Neumann PJ, Weeks JC. Effectiveness of chemotherapy for advanced lung cancer in the elderly: instrumental variable and propensity analysis. J Clin Oncol. 2001;19:1064–70.PubMedGoogle Scholar
  15. 15.
    Martens EP, Pestman WR, de Boer A, Belitser SV, Klungel OH. Instrumental variables application and limitations. Epidemiology. 2006;17:260–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Loisel P, Durand MJ, Diallo B, Vachon B, Charpentier N, Labelle J. From evidence to community practice in work rehabilitation: the Quebec experience. Clin J Pain. 2003;19:105–13.PubMedCrossRefGoogle Scholar
  17. 17.
    Nielsen MBD, Bultmann U, Madsen IEH, Martin MHT, Christensen U, Diderichsen F, et al. Health, work, and personal-related predictors of time to return to work among employees with mental health problems. Disabil Rehabil. 2012;34:1311–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Hernan MA, Robins JM. Instruments for causal inference: an epidemiologist’s dream? Epidemiology. 2006;17:360–72.PubMedCrossRefGoogle Scholar
  19. 19.
    Angrist JD, Imbens GW, Rubin DB. Identification of causal effects using instrumental variables. JASA. 1996;91:444–55.CrossRefGoogle Scholar
  20. 20.
    Cousens S, Hargreaves J, Bonell C, Armstrong B, Thomas J, Kirkwood BR, et al. Alternatives to randomisation in the evaluation of public-health interventions: statistical analysis and causal inference. J Epidemiol Community Health. 2011;65:576–81.PubMedCrossRefGoogle Scholar
  21. 21.
    Cole JA, Norman H, Weatherby LB, Walker AM. Drug copayment and adherence in chronic heart failure: effect on cost and outcomes. Pharmacotherapy. 2006;26:1157–64.PubMedCrossRefGoogle Scholar
  22. 22.
    Brookhart MA, Rassen JA, Schneeweiss S. Instrumental variable methods in comparative safety and effectiveness research. Pharmacoepidemiol Drug Saf. 2010;19:537–54.PubMedCrossRefGoogle Scholar
  23. 23.
    Martin MHT, Nielsen MBD, Petersen SMA, Jakobsen LM, Rugulies R. Implementation of a coordinated and tailored return-to-work intervention for employees with mental health problems. J Occup Rehabil. 2012;22:427–36.PubMedCrossRefGoogle Scholar
  24. 24.
    World Health Organization. International statistical classification of diseases and related health problems, 10th revision (ICD-10). Geneva: World Health Organization; 1992.Google Scholar
  25. 25.
    World Health Organization. International classification of functioning, disability and health (ICF). Geneva: World Health Organization; 2007.Google Scholar
  26. 26.
    Sekjær, K. Stadigt flere psykisk syge må vente på behandling [Increasing number of mentally ill must wait for treatment] [Danish]. Available from: http://www.information.dk/259442.
  27. 27.
    Pedersen J, Villadsen E, Burr H, Martin MHT, Nielsen MBD, Meinertz L. Register for sygedagpenge og sociale ydelser i Danmark [The Danish register of sickness absence compensation and social transfer payments] [Danish]. Copenhagen: The National Research Centre for the Working Environment; 2011.Google Scholar
  28. 28.
    Nielsen MBD, Madsen IEH, Bültmann U, Christensen U, Diderichsen F, Rugulies R. Predictors of return to work in employees sick-listed with mental health problems: findings from a longitudinal study. Eur J Public Health. 2011;21:806–11.PubMedCrossRefGoogle Scholar
  29. 29.
    Sell L, Bültmann U, Rugulies R, Villadsen E, Faber A, Sogaard K. Predicting long-term sickness absence and early retirement pension from self-reported work ability. Int Arch Occ Env Health. 2009;82:1133–8.CrossRefGoogle Scholar
  30. 30.
    Virtanen M, Kawachi I, Oksanen T, Salo P, Tuisku K, Pulkki-Raback L, et al. Socio-economic differences in long-term psychiatric work disability: prospective cohort study of onset, recovery and recurrence. Occup Environ Med. 2011;68:791–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Blank L, Peters J, Pickvance S, Wilford J, MacDonald E. A systematic review of the factors which predict return to work for people suffering episodes of poor mental health. J Occup Rehabil. 2008;18:27–34.PubMedCrossRefGoogle Scholar
  32. 32.
    Rose D, Harrison E. The European socio-economic classification: a new social class schema for comparative European research. Eur Societies. 2007;9:459–90.CrossRefGoogle Scholar
  33. 33.
    Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–83.PubMedCrossRefGoogle Scholar
  34. 34.
    Bech P, Rasmussen NA, Olsen LR, Noerholm V, Abildgaard W. The sensitivity and specificity of the Major Depression Inventory, using the Present State Examination as the index of diagnostic validity. J Affect Dis. 2001;66:159–64.PubMedCrossRefGoogle Scholar
  35. 35.
    Derogatis LR. SCL-90-R. Administration, scoring and procedures. MANUAL-II. Townson MD, 1983.Google Scholar
  36. 36.
    Durlak JA, DuPre EP. Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol. 2008;41:327–50.PubMedCrossRefGoogle Scholar
  37. 37.
    Rebergen DS, Bruinvels DJ, Bos CM, van der Beek AJ, van Mechelen W. Return to work and occupational physicians’ management of common mental health problems–process evaluation of a randomized controlled trial. Scand J Work Environ Health. 2010;36:488–98.PubMedCrossRefGoogle Scholar
  38. 38.
    Aust B, Helverskov T, Nielsen MB, Bjorner JB, Rugulies R, Nielsen K, et al. The Danish national return-to-work program–aims, content, and design of the process and effect evaluation. Scand J Work Environ Health. 2012;38:120–33.PubMedCrossRefGoogle Scholar
  39. 39.
    Loisel P, Durand P, Abenhaim L, Gosselin L, Simard R, Turcotte J, et al. Management of occupational back pain—the Sherbrooke model—results of a pilot and feasibility study. Occup Environ Med. 1994;51:597–602.PubMedCrossRefGoogle Scholar
  40. 40.
    Punnett L, Wegman DH. Work-related musculoskeletal disorders: the epidemiologic evidence and the debate. J Electromyograph Kinesiol. 2004;14:13–23.CrossRefGoogle Scholar
  41. 41.
    Romanov K, Appelberg K, Honkasalo ML, Koskenvuo M. Recent interpersonal conflict at work and psychiatric morbidity: a prospective study of 15,530 employees aged 24–64. J Psychosom Res. 1996;40:169–76.PubMedCrossRefGoogle Scholar
  42. 42.
    Stansfeld S, Candy B. Psychosocial work environment and mental health: a meta-analytic review. Scand J Work Env Health. 2006;32:443–62.CrossRefGoogle Scholar
  43. 43.
    Netterstrøm B, Conrad N, Bech P, Fink P, Olsen O, Rugulies R, et al. The relation between work-related psychosocial factors and the development of depression. Epidemiol Rev. 2008;30:118–32.PubMedCrossRefGoogle Scholar
  44. 44.
    Hensing G, Wahlstrom R. Chapter 7. Sickness absence and psychiatric disorders. Scand J Public Health. 2004;32:152–80.CrossRefGoogle Scholar
  45. 45.
    Schademan HK, Jensen S, Thuesen F, Holt H. Virksomhedernes sociale engagement [Corporate social responsibility] [Danish]. Copenhagen: SFI—The Danish National Centre for Social Research; 2008.Google Scholar
  46. 46.
    Høgelund J, Holm A, McIntosh J. Does graded return-to-work improve sick-listed workers’ chance of returning to regular working hours? J Health Econ. 2010;29:158–69.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Marie H. T. Martin
    • 1
    • 2
  • Maj Britt D. Nielsen
    • 1
  • Ida E. H. Madsen
    • 1
  • Signe M. A. Petersen
    • 1
  • Theis Lange
    • 4
  • Reiner Rugulies
    • 1
    • 2
    • 3
  1. 1.National Research Centre for the Working EnvironmentCopenhagenDenmark
  2. 2.Department of PsychologyUniversity of CopenhagenCopenhagenDenmark
  3. 3.Department of Public HealthUniversity of CopenhagenCopenhagenDenmark
  4. 4.Department of BiostatisticsUniversity of CopenhagenCopenhagenDenmark

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