Psychiatry and Primary CareEffectiveness of an intervention to reduce sickness absence in patients with emotional distress or minor mental disorders: a randomized controlled effectiveness trial☆,☆☆,★
Introduction
Mental problems, whether subclinical or Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) [1] diagnoses, have an impact on well-being and quality of life. They are common in the community and in primary care [2], [3], and often affect functioning to such an extent that they are associated with absenteeism [4], [5]. In The Netherlands, about one third of the people receiving disability benefits do so because of mental health problems, the majority of which are minor mental health problems, including emotional distress [6]. In other European countries, mild mental disorders account for major incapacity benefit claims [7]. Until today, it has remained unclear how these patients should best be treated in order to improve functioning and clinical symptoms and to prevent long-term absenteeism. In this paper, we report the results of a pragmatic randomized controlled trial, which compares the effectiveness of an intervention, delivered by social workers, designed to improve well-being and to reduce sick leave duration with the effectiveness of general practitioners' (GPs) usual care.
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Procedure
Between August 2001 and July 2003, patients were recruited by 70 GPs in the city of Almere, The Netherlands. Inclusion criteria were as follows: (1) suffering from emotional distress or minor mental disorders according to GPs and self-report; (2) on paid employment; (3) on sick leave or is planning to be on sick leave directly after visit to a GP for emotional or mental problems for no longer than 3 months (because the study was about the prevention of long-term absenteeism); (4) aged 18–60
Results
A total of 370 patients gave permission to the researchers to contact them regarding the study. As can be seen in Fig. 1, 194 patients participated in the study; 98 patients were randomized to the experimental treatment and 96 were randomized to the control group. Patient characteristics are displayed in Table 1. At baseline, the groups did not differ significantly in terms of age, sex, educational level, marital status or nationality. The difference in dropout between the two groups was not
Discussion
In the present study, the activating intervention delivered by social workers did not prove superior to GPs' usual care in reducing sick leave duration in patients with emotional distress or minor mental disorders. Neither was it superior in improving anxiety, depression, distress, somatization or functional disability scores, all of which improved in both groups, nearing normal scores usually between 3 and 6 months after baseline. Only patient satisfaction was higher in the intervention group.
Acknowledgment
We would like to thank all patients, GPs and social workers who participated in this trial. We are also grateful to Minke Baumfalk and Anke Wigboldus for their help in organizing our meetings with social workers, and to Jos Twisk and Peter Spreeuwenberg for their statistical advice.
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Funding: The trial was supported by a grant from The Netherlands Organisation for Health Research and Development (grant no. 2200.0100).
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The views expressed in this paper are those of the authors only and are not attributable to The Netherlands Organisation for Health Research and Development.
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Conflict of interest: B.T. played an important role in the development of the intervention under study and received a fee for speaking at a symposium of social workers specialized in occupational care.