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

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.

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Cost-effectiveness of referral for generic care or problem-solving treatment from community mental health nurses, compared with usual general practitioner care for common mental disorders

The British Journal of Psychiatry ◽

10.1192/bjp.bp.105.012435 ◽

2006 ◽

Vol 189 (1) ◽

pp. 50-59 ◽

Cited By ~ 40

Author(s):

Tony Kendrick ◽

Lucy Simons ◽

Laurence Mynors-Wallis ◽

Alastair Gray ◽

Judith Lathlean ◽

...

Keyword(s):

Mental Health ◽

Cost Effectiveness ◽

Problem Solving ◽

Community Mental Health ◽

Mental Disorders ◽

Common Mental Disorders ◽

Mental Health Nurses ◽

Nurse Care ◽

Gp Care ◽

Community Mental Health Nurses

BackgroundUK general practitioners (GPs) refer patients with common mental disorders to community mental health nurses.AimsTo determine the effectiveness and cost-effectiveness of this practice.MethodRandomised trial with three arms: usual GP care, generic mental health nurse care, and care from nurses trained in problem-solving treatment; 98 GPs in 62 practices referred 247 adult patients with new episodes of anxiety, depression and life difficulties, to 37 nurses.ResultsThere were 212 (86%) and 190 (77%) patients followed up at 8 and 26 weeks respectively. No significant differences between groups were found in effectiveness at either point. Mean differences in Clinical Interview Schedule – Revised scores at 26 weeks compared with GP care were –1.4 (95% Cl –5.5 to 2.8) for generic nurse care, and 1.1 (–2.9 to 5.1) for nurse problem-solving. Satisfaction was significantly higher in both nurse-treated groups. Mean extra costs per patient were £283 (95% Cl 154–411) for generic nurse care, and £315 (183–481) for nurse problem-solving treatment.ConclusionsGPs should not refer unselected patients with common mental disorders to specialist nurses. Problem-solving should be reserved for patients who have not responded to initial GP care.

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Food insecurity and common mental disorders in perinatal women living in low socio-economic settings in Cape Town, South Africa during the COVID-19 pandemic: a cohort study

10.21203/rs.3.rs-692244/v2 ◽

2021 ◽

Author(s):

Zulfa Abrahams ◽

Crick Lund

Keyword(s):

Mental Health ◽

South Africa ◽

Mental Disorders ◽

Food Insecurity ◽

Common Mental Disorders ◽

Cape Town ◽

Baseline Risk ◽

Multivariable Logistic Regression Analysis ◽

Perinatal Women

Abstract Background Common mental disorders (CMDs) such as depression and anxiety are highly prevalent during the perinatal period, and are associated with poverty, food insecurity and domestic violence. We used data collected from perinatal women at two time-points during the COVID-19 pandemic to test the hypotheses that (1) socio-economic adversities at baseline would be associated with higher CMD prevalence at follow-up and (2) worse mental health at baseline would be associated with higher food insecurity prevalence at follow-up. Methods Telephonic interviews were conducted with perinatal women attending healthcare facilities in Cape Town, South Africa. Multivariable logistic regression analysis was used to model the associations of baseline risk factors with the prevalence of household food insecurity and CMD at 3 months follow-up. Results At baseline 859 women were recruited, of whom 217 (25%) were pregnant, 106 (12%) had probable CMD, and 375 (44%) were severely food insecure. At follow-up (n=634), 22 (4%) were still pregnant, 44 (7%) had probable CMD, and 207 (33%) were severely food insecure. In the multivariable regression model, after controlling for confounders, the odds of being food insecure at follow-up were greater in women who were unemployed [OR=2.05 (1.46-2.87); p<0.001] or had probable CMD [OR=2.37 (1.35-4.18); p=0.003] at baseline; and the odds of probable CMD at follow-up were greater in women with psychological distress [OR=2.81 (1.47-5.39); p=0.002] and abuse [OR=2.47 (1.47-4.39); p=0.007] at baseline. Conclusions This study highlights the complex bidirectional relationship between mental health and socioeconomic adversity among perinatal women during the COVID-19 pandemic.

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External validation of a prediction model and decision tree for sickness absence due to mental disorders

International Archives of Occupational and Environmental Health ◽

10.1007/s00420-020-01548-z ◽

2020 ◽

Vol 93 (8) ◽

pp. 1007-1012

Author(s):

Marieke F. A. van Hoffen ◽

Giny Norder ◽

Jos W. R. Twisk ◽

Corné A. M. Roelen

Keyword(s):

Mental Disorders ◽

Occupational Health ◽

Decision Tree ◽

Prediction Model ◽

Sickness Absence ◽

Health Survey ◽

Characteristic Curve ◽

External Validation ◽

Increased Risk

Abstract Purpose A previously developed prediction model and decision tree were externally validated for their ability to identify occupational health survey participants at increased risk of long-term sickness absence (LTSA) due to mental disorders. Methods The study population consisted of N = 3415 employees in mobility services who were invited in 2016 for an occupational health survey, consisting of an online questionnaire measuring the health status and working conditions, followed by a preventive consultation with an occupational health provider (OHP). The survey variables of the previously developed prediction model and decision tree were used for predicting mental LTSA (no = 0, yes = 1) at 1-year follow-up. Discrimination between survey participants with and without mental LTSA was investigated with the area under the receiver operating characteristic curve (AUC). Results A total of n = 1736 (51%) non-sick-listed employees participated in the survey and 51 (3%) of them had mental LTSA during follow-up. The prediction model discriminated (AUC = 0.700; 95% CI 0.628–0.773) between participants with and without mental LTSA during follow-up. Discrimination by the decision tree (AUC = 0.671; 95% CI 0.589–0.753) did not differ significantly (p = 0.62) from discrimination by the prediction model. Conclusion At external validation, the prediction model and the decision tree both poorly identified occupational health survey participants at increased risk of mental LTSA. OHPs could use the decision tree to determine if mental LTSA risk factors should be explored in the preventive consultation which follows after completing the survey questionnaire.

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

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17145234 ◽

2020 ◽

Vol 17 (14) ◽

pp. 5234

Author(s):

Marijke Keus Van De Poll ◽

Gunnar Bergström ◽

Irene Jensen ◽

Lotta Nybergh ◽

Lydia Kwak ◽

...

Keyword(s):

Cost Effectiveness ◽

Problem Solving ◽

Mental Disorders ◽

Sickness Absence ◽

Common Mental Disorders ◽

Cost Benefit ◽

Cost Effective ◽

Production Loss ◽

The Cost

The cost-benefit and cost-effectiveness of a work-directed intervention implemented by the occupational health service (OHS) for employees with common mental disorders (CMD) or stress related problems at work were investigated. The economic evaluation was conducted in a two-armed clustered RCT. Employees received either a problem-solving based intervention (PSI; n = 41) or care as usual (CAU; n = 59). Both were work-directed interventions. Data regarding sickness absence and production loss at work was gathered during a one-year follow-up. Bootstrap techniques were used to conduct a Cost-Benefit Analysis (CBA) and a Cost-Effectiveness Analysis (CEA) from both an employer and societal perspective. Intervention costs were lower for PSI than CAU. Costs for long-term sickness absence were higher for CAU, whereas costs for short-term sickness absence and production loss at work were higher for PSI. Mainly due to these costs, PSI was not cost-effective from the employer’s perspective. However, PSI was cost-beneficial from a societal perspective. CEA showed that a one-day reduction of long-term sickness absence costed on average €101 for PSI, a cost that primarily was borne by the employer. PSI reduced the socio-economic burden compared to CAU and could be recommended to policy makers. However, reduced long-term sickness absence, i.e., increased work attendance, was accompanied by employees perceiving higher levels of production loss at work and thus increased the cost for employers. This partly explains why an effective intervention was not cost-effective from the employer’s perspective. Hence, additional adjustments and/or support at the workplace might be needed for reducing the loss of production at work.

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Associations between workplace bullying and later benefit recipiency among workers with common mental disorders

International Archives of Occupational and Environmental Health ◽

10.1007/s00420-021-01764-1 ◽

2021 ◽

Author(s):

Camilla Løvvik ◽

Simon Øverland ◽

Morten Birkeland Nielsen ◽

Henrik Børsting Jacobsen ◽

Silje Endresen Reme

Keyword(s):

Social Support ◽

Mental Disorders ◽

Sickness Absence ◽

Workplace Bullying ◽

Common Mental Disorders ◽

Controlled Trial ◽

Work Participation ◽

Randomized Controlled

Abstract Objective In this study, we examined exposure to workplace bullying as a predictor of registry-based benefit recipiency among workers struggling with work participation due to common mental disorders. Further, we examined if the experience of receiving social support moderated the association between workplace bullying and benefit recipiency. Design Secondary analyses of a randomized controlled trial. Patients People struggling with work participation due to common mental disorders (CMD). Methods Study participants (n = 1193) were from a randomized controlled trial (The At Work and Coping trial (AWaC), trial registration http://www.clinicaltrials.gov NCT01146730), and self-reported CMD as a main obstacle for work participation. Participants were at risk of sickness absence, currently on sickness absence or on long-term benefits. Benefit recipiency indicated sickness absence and/or long-term benefits (i.e., disability pension) at 6-month follow-up. Results Of the 1193 participants, 36% reported exposure to workplace bullying. Workplace bullying was significantly associated with benefit recipiency at 6-month follow-up (OR 1.41, CI 1.11–1.79). Social support did not moderate the association between bullying and benefit recipiency. Conclusions The finding that workplace bullying increases the risk of later benefit recipiency suggest that bullying is a significant obstacle for work participation.

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Sickness certification for common mental disorders and GP return-to-work advice

Primary Health Care Research & Development ◽

10.1017/s1463423616000074 ◽

2016 ◽

Vol 17 (05) ◽

pp. 437-447 ◽

Cited By ~ 5

Author(s):

Mark Gabbay ◽

Chris Shiels ◽

Jim Hillage

Keyword(s):

Mental Health ◽

Mental Disorders ◽

Return To Work ◽

Sickness Absence ◽

Mental Health Problems ◽

Common Mental Disorders ◽

Health Problems ◽

Sickness Certification ◽

Mental Health Diagnoses ◽

To Receive

AimTo report the types and duration of sickness certification for different common mental disorders (CMDs) and the prevalence of GP advice aimed at returning the patient to work.BackgroundIn the United Kingdom, common mental health problems, such and depression and stress, have become the main reasons for patients requesting a sickness certificate to abstain from usual employment. Increasing attention is being paid to mental health and its impact on employability and work capacity in all parts of the welfare system. However, relatively little is known about the extent to which different mental health diagnoses impact upon sickness certification outcomes, and how the GP has used the new fit note (introduced in 2010) to support a return to work for patients with mental health diagnoses.MethodsSickness certification data was collected from 68 UK-based general practices for a period of 12 months.FindingsThe study found a large part of all sickness absence certified by GPs was due to CMDs (29% of all sickness absence episodes). Females, younger patients and those living in deprived areas were more likely to receive a fit note for a CMD (compared with one for a physical health problem). The highest proportion of CMD fit notes were issued for ‘stress’. However, sickness certification for depression contributed nearly half of all weeks certified for mental health problems. Only 7% of CMD fit notes included any ‘may be fit’ advice from the GP, with type of advice varying by mental health diagnostic category. Patients living in the most socially deprived neighbourhoods were less likely to receive ‘may be fit’ advice on their CMD fit notes.

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Diagnosis-Specific Sickness Absence and Subsequent Common Mental Disorders: A Register-Linkage Cohort Study among Finnish Public Sector Employees

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17030782 ◽

2020 ◽

Vol 17 (3) ◽

pp. 782

Author(s):

Elina Mauramo ◽

Tea Lallukka ◽

Minna Mänty ◽

Hilla Sumanen ◽

Olli Pietiläinen ◽

...

Keyword(s):

Mental Health ◽

Logistic Regression ◽

Mental Disorders ◽

Sickness Absence ◽

Common Mental Disorders ◽

Musculoskeletal Diseases ◽

Multinomial Logistic Regression ◽

General Health Questionnaire ◽

Health Behaviours ◽

Health Study

Sickness absence is associated with poor health outcomes, but little is known about its consequences for general mental health. This study examined the associations between diagnosis-specific sickness absence and subsequent common mental disorders (CMD). Register data on medically certified all-cause sickness absence and sickness absence due to mental disorders and musculoskeletal diseases from 2004–2007 were linked to the Helsinki Health Study 2007 and 2012 survey data on City of Helsinki employees in Finland (N = 3560). Using logistic regression and multinomial logistic regression, we analysed the associations between the total number of reimbursed sickness absence days in 2004-7 and CMD General Health Questionnaire 12) in 2007 and 2012 and CMD changes. Sickness absence due to mental disorders (age- and sex-adjusted odds ratio (OR)range: 2.16 to 2.93), musculoskeletal diseases (OR range: 2.79 to 2.93) and all-cause sickness absence (OR range: 1.48 to 3.20) were associated with CMD in 2007. In 2012, associations with lower ORs were observed. Associations were also found with changing and especially repeated (OR range: 1.49 to 3.40) CMD. The associations remained after adjusting for work-related covariates and health behaviours. Diagnosis-specific sickness absence showed persistent associations with subsequent CMD and their changes. Attention should be paid to both the short- and long-term consequences of sickness absence for employee mental health.

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Economic Evaluation of a Problem Solving Intervention to Prevent Recurrent Sickness Absence in Workers with Common Mental Disorders

PLoS ONE ◽

10.1371/journal.pone.0071937 ◽

2013 ◽

Vol 8 (8) ◽

pp. e71937 ◽

Cited By ~ 11

Author(s):

Iris Arends ◽

Ute Bültmann ◽

Willem van Rhenen ◽

Henk Groen ◽

Jac J. L. van der Klink

Keyword(s):

Economic Evaluation ◽

Problem Solving ◽

Mental Disorders ◽

Sickness Absence ◽

Common Mental Disorders ◽

Recurrent Sickness Absence

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Food insecurity and common mental disorders in perinatal women living in low socio-economic settings in Cape Town, South Africa during the COVID-19 pandemic: a cohort study

10.21203/rs.3.rs-692244/v1 ◽

2021 ◽

Author(s):

Zulfa Abrahams ◽

Crick Lund

Keyword(s):

Mental Health ◽

South Africa ◽

Cohort Study ◽

Mental Disorders ◽

Food Insecurity ◽

Common Mental Disorders ◽

Household Food Insecurity ◽

Household Food ◽

Perinatal Women

Abstract Objective: Common mental disorders (CMDs) such as depression and anxiety are highly prevalent during the perinatal period, and are associated with food insecurity, domestic violence and lack of social support. This study explores the relationship between household food insecurity, mental health status and several adverse social and economic factors experienced by perinatal women during the COVID-19 pandemic.Design: Cohort study, using telephonic interviews at two time-points, three months apart. Logistic regression analysis was used to model the associations of several baseline risk factors with the occurrence of household food insecurity at follow-up as the outcome.Setting: Midwife obstetric units or basic antenatal care units in Cape Town, South Africa.Participants: The sample comprised of 880 perinatal women at baseline and 660 women at follow-up. Results: At baseline 23% were pregnant, 54% were unemployed, 13% had a probable CMD, 43% were severely food insecure and 21% experienced domestic abuse in the past year. Of the 660 women interviewed at follow-up, 71% were unemployment, 3.5% were pregnant, 7% had a probable CMD, and 32% were severely food insecure. In the multivariate regression model, after controlling for ethnicity, number of children, being HIV-infected, and having a planned pregnancy, the odds of being food insecure were greater in women who were unemployed (OR=1.88; p=0.001) or had probable CMD (OR=2.20; p=0.019) at baseline. Conclusions: This study highlights a range of socio-demographic and mental health related variables that predict food insecurity among perinatal women during the COVID-19 pandemic.

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Early intervention, treatment and rehabilitation of employees with common mental disorders by using psychotherapeutic consultation at work: study protocol of a randomised controlled multicentre trial (friaa project)

BMC Public Health ◽

10.1186/s12889-021-11195-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jeannette Weber ◽

Peter Angerer ◽

Lorena Brenner ◽

Jolanda Brezinski ◽

Sophia Chrysanthou ◽

...

Keyword(s):

Mental Disorders ◽

Sickness Absence ◽

Multicentre Trial ◽

Common Mental Disorders ◽

Intervention Group ◽

Control Group ◽

Medical Indication ◽

Work Related ◽

Randomised Controlled

Abstract Background Common mental disorders are one of the leading causes for sickness absence and early retirement due to reduced health. Furthermore, a treatment gap for common mental disorders has been described worldwide. Within this study, psychotherapeutic consultation at work defined as a tailored, module-based and work-related psychotherapeutic intervention will be applied to improve mental health care. Methods This study comprises a randomised controlled multicentre trial with 1:1 allocation to an intervention and control group. In total, 520 employees with common mental disorders shall be recruited from companies being located around five study centres in Germany. Besides care as usual, the intervention group will receive up to 17 sessions of psychotherapy. The first session will include basics diagnostics and medical indication of treatment and the second session will include work-related diagnostics. Then, participants of the intervention group may receive work-related psychotherapeutic consultation for up to ten sessions. Further psychotherapeutic consultation during return to work for up to five sessions will be offered where appropriate. The control group will receive care as usual and the first intervention session of basic diagnostics and medical indication of treatment. After enrolment to the study, participants will be followed up after nine (first follow-up) and fifteen (second follow-up) months. Self-reported days of sickness absence within the last 6 months at the second follow-up will be used as the primary outcome and self-efficacy at the second follow-up as the secondary outcome. Furthermore, a cost-benefit assessment related to costs of common mental disorders for social insurances and companies will be performed. Discussion Psychotherapeutic consultation at work represents a low threshold care model aiming to overcome treatment gaps for employees with common mental disorders. If successfully implemented and evaluated, it might serve as a role model to the care of employees with common mental disorders and might be adopted in standard care in cooperation with sickness and pension insurances in Germany. Trial registration The friaa project was registered at the German Clinical Trial Register (DRKS) at 01.03.2021 (DRKS00023049): https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023049.

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