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Problem-Based Self-care Groups Versus Cognitive Behavioural Therapy for Persons on Sick Leave Due to Common Mental Disorders: A Randomised Controlled Study

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Abstract

Purpose To evaluate the interventional capacity of problem based method groups (PBM) regarding mental health and work ability compared to cognitive behavioural therapy (CBT) for persons on sick leave due to common mental disorders. Methods In a randomised controlled design the experimental group received PBM and the control group received CBT. Outcomes were measured by the Hospital Anxiety and Depression Scale (HADS), the Stress and Crisis Inventory 93 (SCI-93) and the Dialogue about Working Ability instrument (DOA). Results Twenty-two participants in the PBM group and 28 in the CBT group completed intervention. Both groups showed significant lower scores on the two HADS subscales. Regarding stress the PBM group showed significant decrease in one (out of three) subscales of SCI-93. The CBT group showed significant decrease on all subscales of SCI-93. Regarding work ability the PBM group showed significant higher scores on one of five subscales of DOA. The CBT group showed significant higher scores on four of five subscales of DOA. Between groups there were significant differences to the favour of CBT on one of two subscales of HADS, all three subscales of SCI-93 and on two of the five subscales of DOA. Conclusion PBM seem to be able to reduce anxiety- and depression symptoms. CBT showed to be superior to PBM in reducing symptoms in all aspects of mental health, except for anxiety, in which they seem equally effective. Regarding work ability CBT showed to be superior, with significant effect on more aspects compared to PBM.

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References

  1. Försäkringskassan [The Swedish Social Insurance Agency]. Socialförsäkringen i siffror 2012 [Social Insurance in figures 2012] (in Swedish). Stockholm: 2012 [cited 2013 Sept 02]. http://www.forsakringskassan.se/irj/go/km/docs/fk_publishing/Dokument/Publikationer/Socialforsakingen.

  2. Organisation for Economic Co-operation and Development. Sick on the job?: Myths and realities about mental health and work. Paris: OECD Publishing; 2012.

    Google Scholar 

  3. Heymann J, Rho HJ, Schmitt J, Earle A. Ensuring a healthy and productive workforce: comparing the generosity of paid sick day and sick leave policies in 22 countries. Int J Health Serv. 2010;40(1):1–22.

    Article  PubMed  Google Scholar 

  4. Hägglund P. Do time limits in the sickness insurance system increase return to work? Empir Econ. 2013;45(1):567–82.

    Article  Google Scholar 

  5. Försäkringskassan [The Swedish Social Insurance Agency]. Sjukskrivning och sjukpenning [Sick leave and sickness benefits] (in Swedish) [cited 2013 Sept 02]. http://www.forsakringskassan.se/sjukvard/sjukskrivning_och_sjukpenning.

  6. Kielhofner G. A model of human occupation: theory and application. Baltimore: Williams & Wilkins; 2008.

    Google Scholar 

  7. Wilcock A. An occupational perspective of health. Thorofare: Slack; 2006.

    Google Scholar 

  8. Jensen I, Busch H. English summary of the national evaluation of the Rehabilitation Guarantee. Karolinska Institutet; 2011 [cited 2013 Sept 02]. http://ki.se/.

  9. Sveriges kommuner och landsting [Swedish Association of Local Authorities and Regions]. Rehabiliteringsgarantin – utveckling och planering i landstingen [The Rehabilitation Guarantee—development and planning in the counties] (in Swedish). Stockholm: SKL; 2011.

  10. World Health Organisation. International classification of diseases. ICD-10 version: 2010 [cited 2013 Sept 02]. http://www.who.int/classifications/icd/en/.

  11. World Health Organisation. International classification of functioning, disability and health (ICF) [cited 2013 Aug 30]. http://www.who.int/classifications/icf/en/.

  12. Socialstyrelsen [The National Board of Health and Welfare]. Nationella riktlinjer för vård vid depression och ångestsyndrom 2010– stöd för styrning och ledning [National guidelines for treatment of depression and anxiety syndromes 2010-support for guiding and direction] (in Swedish) [cited 2013 Sept 03]. http://www.socialstyrelsen.se/lists/artikelkatalog/attachments/17948/2010-3-4.pdf.

  13. Blonk RWB, Brenninkmeijer V, Lagerveld SE, Houtman ILD. Return to work: a comparison of two cognitive behavioural interventions in cases of work-related psychological complaints among the self-employed. Work Stress. 2006;20(2):129–44.

    Article  Google Scholar 

  14. Hofmann SG, Asnaani A, Vonk IJJ, Sawyer AT, Fang A. The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognit Ther Res. 2012;36(5):427–40.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Passer MW, Smith RE. Psychology. The science of mind and behaviour. 2nd ed. New York: McGraw-Hill; 2004.

    Google Scholar 

  16. Weissman MM, Markowitz JC, Klerman GL. Comprehensive guide to interpersonal psychotherapy. New York: BasicBooks; 2000.

    Google Scholar 

  17. Arneson H, Ekberg K. Evaluation of empowerment processes in a workplace health promotion intervention based on learning in Sweden. Health Promot Int. 2005;20(4):351–9.

    Article  PubMed  Google Scholar 

  18. Lindroth Y, Brattstrom M, Bellman I, Ekestaf G, Olofsson Y, Strombeck B, et al. A problem-based education program for patients with rheumatoid arthritis: evaluation after three and twelve months. Arthritis Care Res. 1997;10(5):325.

    Article  CAS  PubMed  Google Scholar 

  19. Tingström P, Kamwendo K, Göransson A, Bergdahl B. Validation and feasibility of problem-based learning in rehabilitation of patients with coronary artery disease. Patient Educ Couns. 2002;47(4):337–45.

    Article  PubMed  Google Scholar 

  20. Kamwendo K, Tingström P, Bergdahl B, Svensson E. Effect of problem-based learning on stages of change for exercise behaviour in patients with coronary artery disease. Physiother Res Int. 2004;9(1):24–32.

    Article  PubMed  Google Scholar 

  21. Tingström PR, Kamwendo K, Bergdahl B. Effects of a problem-based learning rehabilitation programme on quality of life in patients with coronary artery disease. Eur J Cardiovasc Nurs. 2005;4(4):324–30.

    Article  PubMed  Google Scholar 

  22. Kärner A, Nilsson S, Jaarsma T, Andersson A, Wiréhn A-B, Wodlin P, et al. The effect of problem-based learning in patient education after an event of coronary heart disease—a randomised study in primary health care: design, methodology of the COR-PRIM study. BMC Fam Pract. 2012;13:110.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Schlundt DG, Flannery ME, Davis DL, Kinzer CK, Pichert JW. Evaluation of a multicomponent, behaviorally oriented, problem-based “summer school” program for adolescents with diabetes. Behav Modif. 1999;23(1):79–105.

    Article  CAS  PubMed  Google Scholar 

  24. Medin J, Bendtsen P, Ekberg K. Health promotion and rehabilitation: a case study. Disabil Rehabil. 2003;25(16):908–15.

    Article  CAS  PubMed  Google Scholar 

  25. Peterson U, Bergström B, Samuelsson M, Åsberg M, Nygren Å. Reflecting peer support groups in the prevention of stress and burnout: randomized controlled trial. J Adv Nurs. 2008;63(5):506–16.

    Article  PubMed  Google Scholar 

  26. Arvidsson S, Bergman S, Arvidsson B, Fridlund B, Tingström P. Effects of a self-care promoting problem-based learning programme in people with rheumatic diseases: a randomized controlled study. J Adv Nurs. 2013;69(7):1500–14.

    Article  PubMed  Google Scholar 

  27. Ekberg K. Workplace changes in successful rehabilitation. J Occup Rehabil. 1995;5:253–69.

    Article  CAS  PubMed  Google Scholar 

  28. Försäkringskassan [The Swedish Social Insurance Agency] Sjukvård/REHSAM [Healthcare/REHSAM] (in Swedish) [cited 2014 Apr 22] https://www.forsakringskassan.se/sjukvard/REHSAM.

  29. SCB [Statistics Sweden]. Länens arbetsmarknad– befolkning, näringsliv, yrken och framtida pensionsavgångar [The labour market in the counties—population, economy, professions and future retirements] (in Swedish) [cited 2013 Aug 23] http://www.scb.se/statistik/_publikationer/UF0521_2007A01_BR_AM78BR1001.pdf.

  30. World Medical Association. World medical association declaration of Helsinki—Ethical principles for medical research involving human subjects 1964 [cited 2014 Jan 02]. http://www.wma.net/en/10home/index.html.

  31. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70.

    Article  CAS  PubMed  Google Scholar 

  32. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002;52(2):69–77.

    Article  PubMed  Google Scholar 

  33. Saboonchi F, Wennman-Larsen A, Alexanderson K, Petersson L-M. Examination of the construct validity of the Swedish version of Hospital Anxiety and Depression Scale in breast cancer patients. Qual Life Res. 2013;22(10):2849–56.

  34. Nyström C, Nyström O. Skattad stress verifierar autonom dysfunktion [Assessed stress verifies autonom dysfunction]. Läkartidningen 1996; 93(28–29):2583–84 (in Swedish).

  35. Krafft B, Nyström C. Hög stressnivå och omogna försvar ger ond cirkel vid långvarig smärta [High stress levels and immature ego defences lead to a vicious circle in pain]. Läkartidningen. 2002; 99(41):4040–43 (in Swedish).

  36. Linddahl I. Validity and reliability of the instrument DOA; a dialogue about working ability [dissertation]. Jönköping: Hälsohögskolan; 2007.

    Google Scholar 

  37. Linddahl I, Norrby E, Bellner A-L. Construct validity of the instrument DOA: a dialogue about ability related to work. Work. 2003;20(3):215–24.

    PubMed  Google Scholar 

  38. Norrby E, Linddahl I. Reliability of the instrument DOA: dialogue about ability related to work. Work. 2006;26(2):131–9.

    PubMed  Google Scholar 

  39. Altman DG. Practical statistics for medical research. London: Chapman and Hall; 1991.

    Google Scholar 

  40. Fukui S, Davidson LJ, Holter MC, Rapp CA. Pathways to recovery (PTR): impact of peer-led group participation on mental health recovery outcomes. Psychiatr Rehabil J. 2010;34(1):42–8.

    Article  PubMed  Google Scholar 

  41. Mikkelsen A, Saksvik PO, Landsbergis P. The impact of a participatory organizational intervention on job stress in community health care institutions. Work Stress. 2000;14(2):156–70.

    Article  Google Scholar 

  42. Mitte K. Review: cognitive behavioural therapy is more effective than control and similarly effective to pharmacotherapy for generalised anxiety disorder. Evid Based Ment Health. 2006;9(2):43.

    Article  Google Scholar 

  43. Dalgren AS, Gard GE. Soft values with hard impact—a review of stress reducing interventions on group and organisational level. Phys Ther Rev. 2009;14(6):369–81.

    Article  Google Scholar 

  44. Richardson KM, Rothstein HR. Effects of occupational stress management intervention programs: a meta-analysis. J Occup Health Psychol. 2008;13(1):69–93.

    Article  PubMed  Google Scholar 

  45. Gardner B, Rose J, Mason O, Tyler P, Cushway D. Cognitive therapy and behavioural coping in the management of work-related stress: an intervention study. Work Stress. 2005;19(2):137–52.

    Article  Google Scholar 

  46. van der Klink JJ, Blonk RW, Schene AH, van Dijk FJ. The benefits of interventions for work-related stress. Am J Public Health. 2001;91(2):270–6.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Granath J, Ingvarsson S, von Thiele U, Lundberg U. Stress management: a randomized study of cognitive behavioural therapy and yoga. Cogn Behav Ther. 2006;35(1):3–10.

    Article  PubMed  Google Scholar 

  48. de Vente W, Kamphuis JH, Emmelkamp 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(3):214–31.

    Article  PubMed  Google Scholar 

  49. Karlson B, Jönsson P, Pålsson B, Abjörnsson G, Malmberg B, Larsson B, et al. Return to work after a workplace-oriented intervention for patients on sick-leave for burnout—a prospective controlled study. BMC Public Health. 2010;10:301.

    Article  PubMed Central  PubMed  Google Scholar 

  50. Escorpizo R, Finger M, Glässel A, Gradinger F, Lückenkemper M, Cieza A. A systematic review of functioning in vocational rehabilitation using the international classification of functioning, disability and health. J Occup Rehabil. 2011;21(2):134–46.

    Article  PubMed  Google Scholar 

  51. Marchington M, Suter J. Where informality really matters: patterns of employee involvement and participation (EIP) in a non-union firm. Ind Relat. 2013;52(S1):284–313.

    Article  Google Scholar 

  52. Smith E, Comyn P. The development of employability skills in novice workers. National Centre for Vocational Education Research (NCVER); 2003.

  53. Biesma RG, Pavlova M, Vaatstra R, van Merode GG, Czabanowska K, Smith T, et al. Generic versus specific competencies of entry-level public health graduates: employers’ perceptions in Poland, the UK, and the Netherlands. Adv Health Sci Educ Theory Pract. 2008;13(3):325–43.

    Article  PubMed  Google Scholar 

  54. Lynøe N, Wessel M, Olsson D, Alexanderson K, Tännsjö T, Juth N. Duelling with doctors, restoring honour and avoiding shame? A cross-sectional study of sick-listed patients’ experiences of negative healthcare encounters with special reference to feeling wronged and shame. J Med Ethics. 2013;39:654–7.

    Article  PubMed  Google Scholar 

  55. Jansson I, Björklund A. The experience of returning to work. Work. 2007;28(2):121–34.

    PubMed  Google Scholar 

  56. Tjulin A, Maceachen E, Ekberg K. Exploring workplace actors experiences of the social organization of return-to-work. J Occup Rehabil. 2010;20(3):311–21.

    Article  PubMed  Google Scholar 

  57. Finger M, Glässel A, Erhart P, Gradinger F, Klipstein A, Rivier G, et al. Identification of relevant ICF categories in vocational rehabilitation: a cross sectional study evaluating the clinical perspective. J Occup Rehabil. 2011;21(2):156–66.

    Article  PubMed  Google Scholar 

  58. Saltychev M, Kinnunen A, Laimi K. Vocational rehabilitation evaluation and the International Classification of Functioning, Disability, and Health (ICF). J Occup Rehabil. 2013;23(1):106–14.

    Article  PubMed  Google Scholar 

  59. Gard G, Larsson A. Focus on motivation in the work rehabilitation planning process: a qualitative study from the employer’s perspective. J Occup Rehabil. 2003;13(3):159–67.

    Article  PubMed  Google Scholar 

  60. Nieuwenhuijsen K, Noordik E, van Dijk FJH, van der Klink JJ. Return to work perceptions and actual return to work in workers with common mental disorders. J Occup Rehabil. 2013;23(2):290–9.

    Article  PubMed  Google Scholar 

  61. Cheng SK. Life stress, problem solving, perfectionism, and depressive symptoms in Chinese. Cogn Therapy Res. 2001;25(3):303.

    Article  Google Scholar 

  62. Dixon WA. Problem-solving appraisal and depression: evidence for a recovery model. J Couns Dev. 2000;78(1):87–91.

    Article  Google Scholar 

  63. Ju S, Zhang D, Pacha J. Employability skills valued by employers as important for entry-level employees with and without disabilities. Career Dev Except Individ. 2012;35(1):29–38.

    Article  Google Scholar 

  64. Downing K, Kwong T, Chan S-W, Lam T-F, Downing W-K. Problem-based learning and the development of metacognition. High Educ. 2009;57:609–21.

    Article  Google Scholar 

  65. Wells A. Emotional disorders and metacognition: innovative cognitive therapy. Chichester: Wiley; 2000.

    Google Scholar 

  66. Bottomley A. To randomise or not to randomise: methodological pitfalls of the RCT design in psychosocial intervention studies. Eur J Cancer Care (Engl). 1997;6(3):222–30.

    Article  CAS  Google Scholar 

  67. Sharp DM, Power KG, Swanson V. A comparison of the efficacy and acceptability of group versus individual cognitive behaviour therapy in the treatment of panic disorder and agoraphobia in primary care. Clin Psychol Psychother. 2004;11(2):73–82.

    Article  Google Scholar 

  68. Lally P, Wardle J, Gardner B. Experiences of habit formation: a qualitative study. Psychol Health Med. 2011;16(4):484–9.

    Article  PubMed  Google Scholar 

  69. Blades D. Women and men in OECD countries. Paris: Organisation for Economic Co-operation and Development (OECD); 2007 [cited 2013 Sept 11]. http://www.oecd.org/dataoecd/44/52/37962502.pdf.

  70. Mastekaasa A, Dale-Olsen H. Do women or men have the less healthy jobs? An analysis of gender differences in sickness absence. Eur Sociol Rev. 2000;16(3):267–86.

    Article  Google Scholar 

  71. Bratberg E, Dahl S-Å, Risa AE. ‘The double burden’: do combinations of career and family obligations increase sickness absence among women? Eur Sociol Rev. 2002;18(2):233–49.

    Article  Google Scholar 

  72. Sveriges kommuner och landsting [Swedish Association of Local Authorities and Regions]. Rehabiliteringsgarantin 2011 – Resultat 2011 [The rehabilitation guarantee 2011—results 2011] (in Swedish). Stockholm: SKL; 2012.

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Acknowledgments

This project was financed by the REHSAM-programme (the Swedish Social Insurance Agency and the Vårdal Foundation), FORSS (the Medical Research Council of Southeast Sweden) and the County Councils in Jönköping and Kalmar, Sweden. We gratefully acknowledge all participants, group leaders, therapists and Susanne Ekdahl, Nyckeln Competence Centre for Pedagogics in Healthcare, Kalmar County Hospital, as well as the project group and all other health care professionals who contributed to this project.

Conflict of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

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Authors and Affiliations

  1. Department of Rehabilitation, School of Health Sciences, 553 18, Jönköping, Sweden

    Inger Jansson & Anita Björklund

  2. Nyckeln Competence Centre for Pedagogic in Healthcare, Kalmar County Hospital, 391 85, Kalmar, Sweden

    Inger Jansson & Kent-Inge Perseius

  3. Unit for Research and Development, Kronoberg County Council, 352 34, Växjö, Sweden

    A. Birgitta Gunnarsson

  4. Kalmar County Hospital, 391 85, Kalmar, Sweden

    Lars Brudin

  5. Department of Medicine and Health Sciences, University Hospital Linköping, 58185, Linköping, Sweden

    Lars Brudin

  6. Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, 171 77, Stockholm, Sweden

    Kent-Inge Perseius

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  1. Inger Jansson
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Correspondence to Inger Jansson.

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Jansson, I., Gunnarsson, A.B., Björklund, A. et al. Problem-Based Self-care Groups Versus Cognitive Behavioural Therapy for Persons on Sick Leave Due to Common Mental Disorders: A Randomised Controlled Study. J Occup Rehabil 25, 127–140 (2015). https://doi.org/10.1007/s10926-014-9530-9

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