An outreach collaborative model for early identification and treatment of mental disorder in Danish workplaces

Helle Østermark Sørensen, Jan B Valentin, Malene Krogsgaard Bording, Jens Ivar Larsen, Anelia Larsen, Øyvind Omland, Helle Østermark Sørensen, Jan B Valentin, Malene Krogsgaard Bording, Jens Ivar Larsen, Anelia Larsen, Øyvind Omland

Abstract

Background: Depression and anxiety are prevalent mental disorders among the working population with potentially high personal and financial cost. The overall aim of this study was to test the applicability of an outreach collaborative model for early identification and treatment of clinical and sub-clinical mental disorders among Danish employees. This applicability was examined by I) investigating the fractions of identified and treated clinical and subclinical cases, II) describing the distribution and characteristics of cases identified and III) investigating the effect of allocated treatment.

Methods: A longitudinal study design with four assessments (T0-T3) over 16 months was applied. Self-reporting questionnaires probing for psychopathology were distributed to all employees in six consecutively enrolled companies at the four time points. Employees meeting the screening criteria at T1 were assessed diagnostically. Subjects diagnosed with a clinical mental disorder were allocated to outpatient psychiatric treatment, and subjects with subclinical conditions were allocated to preventive cognitive behavioural therapy. Follow-up was conducted 6 and 12 months after initiation of treatment. We used chi-squared test and F-test to compare the different groups on baseline characteristics and mixed effects linear regression to analyse the treatment effects.

Results: Forty (6.8%) of the 586 responders at T1 were diagnosed with a clinical mental disorder and referred to outpatient psychiatric treatment. Thirty-three (5.6%) were affected by a subclinical condition and referred to preventive treatment. Nearly two-thirds (63%) of the employees diagnosed with a clinical condition had never received treatment before. Symptom severity decreased significantly for both treated groups until follow-up. When compared to a composed control group, subclinical cases displayed a more rapid initial significant symptomatic decrease on the global symptom scale (coefs = - 0.914, 95% CI [- 1.754, - 0,075]) and anxiety sub-scale (coefs = - 1.043, 95% CI [- 2.021, - 0.066]). This did not apply to the clinical cases as no significant difference in change were identified.

Conclusions: The outreach collaborative model demonstrated an applicability to identify both clinical and subclinical cases, among these a high number of employees with an unmet need for treatment. We found evidence of a positive initial effect on symptomatology from the allocated preventive treatment among the subclinical cases, but not for clinical cases.

Trial registration: Retrospectively registered at December 18, 2018 at clinicaltrials.gov, identifier: NCT03786328 .

Keywords: Anxiety; Depression; Early identification; Longitudinal study; Outreach collaborative model; Unmet treatment need; Workplace.

Conflict of interest statement

Ethics approval and consent to participate

The project was approved by the Danish Data Protection Agency (j. 2008-58-0028). The project was presented to the Danish Scientific Ethics Committee (N-20070016), but the need for approval was waived due to the nature of the study. Written informed consent was obtained from all participants involved in diagnostic interview and treatment.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study time line
Fig. 2
Fig. 2
Screening and identification of clinical and subclinical cases of mental disorders

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