Preventing sickness absenteeism among employees with common mental disorders or stress-related symptoms at work: Design of a cluster randomized controlled trial of a problem-solving based intervention versus care-as-usual conducted at the Occupational Health Services

G Bergström, M Lohela-Karlsson, L Kwak, L Bodin, I Jensen, M Torgén, L Nybergh, G Bergström, M Lohela-Karlsson, L Kwak, L Bodin, I Jensen, M Torgén, L Nybergh

Abstract

Background: Common mental disorders (CMDs) are among the leading causes of sick leave in Sweden and other OECD countries. They result in suffering for the individual and considerable financial costs for the employer and for society at large. The occupational health service (OHS) can offer interventions in which both the individual and the work situation are taken into account. The aim of this paper is to describe the design of a study evaluating the effectiveness of an intervention given at the OHS to employees with CMDs or stress-related symptoms at work. In addition, intervention fidelity and its relation to the outcome will be assessed in a process analysis.

Methods: The study is designed as a cluster randomized trial in which the participating OHS consultants are randomized into either delivering the intervention or performing care as usual. Employees with CMDs or stress-related symptoms at work are recruited consecutively by the OHS consultants. The intervention aims to improve the match between the employee and the job situation. Interviews are held individually with the employee and the nearest supervisor, after which a joint meeting with both the employee and the supervisor takes place. A participatory approach is applied by which the supervisor and the employee are guided by the OHS consultant and encouraged to actively take part in problem solving concerning the work situation. Outcomes will be assessed at baseline and at six and 12 months. A long-term follow-up at 3 years will also be performed. The primary outcome is registered sickness absence during a 1-year period after study inclusion. Secondary outcomes are mental health and work ability. The intervention's cost effectiveness, compared to treatment as usual, both for society and for the employer will be evaluated. A process evaluation by both the OHS consultants and the employee will be carried out.

Discussion: The study includes analyses of the effectiveness of the intervention (clinical and economic) as well as an analysis of its implementation at the participating OHSs. Possible methodological challenges such as selection bias and risk of contamination between OHS consultants delivering the experimental condition and consultants giving usual care are discussed.

Trial registration: ClinicalTrials NCT02563743 Sep 28 2015.

Keywords: Adjustment disorders; Cluster randomized study; Common mental disorders; Depression; Exhaustion; Occupational health services; Participative methodology; Problem solving therapy; Stress-related disorders; Work environment.

Figures

Fig. 1
Fig. 1
Study design and overview of the trial
Fig. 2
Fig. 2
Overview of the intervention

References

    1. Försäkringskassan . The social Insurance in Numbers (in Swedish) Stockholm. 2016.
    1. OECD . Fit mind, fit job. From evidence to practice in mental health and work. Paris: OECD Publishing; 2015.
    1. McDaid D. Mental health in workplace settings. Consensus paper. Luxembourg: European Communities; 2008.
    1. Bryngelson A, Asberg M, Nygren A, Jensen I, Mittendorfer-Rutz E. All-cause and cause-specific mortality after long-term sickness absence for psychiatric disorders: a prospective cohort study. PLoS One. 2013;8(6):e67887. doi: 10.1371/journal.pone.0067887.
    1. SBU. Occupational exposures and symptoms of depression and burnout (in Swedish - English summary). Stockholm: Swedish Council on Health Technology Assessment (SBU); 2014. Report no 223. .
    1. Stansfeld S, Candy B. Psychosocial work environment and mental health—a meta-analytic review. Scand J Work Environ Health. 2006:443–62.
    1. (SBU) SBfMU . Arbetsmiljöns betydelse för symtom på depression och utmattningssyndrom. Stockholm: En systematisk litteraturöversikt; 2014.
    1. EU-OSHA . Research review on rehabilitation and return to work. 2016.
    1. Nieuwenhuijsen K, Faber B, Verbeek JH, Neumeyer-Gromen A, Hees HL, Verhoeven AC, van der Feltz-Cornelis CM, Bultmann U. Interventions to improve return to work in depressed people. Cochrane Database Syst Rev. 2014;12:CD006237.
    1. Nieuwenhuijsen K, Bültmann U, Neumeyer-Gromen A, Verhoeven AC, Verbeek JH, Feltz-Cornelis CM. Interventions to improve occupational health in depressed people. Cochrane Libr. 2008;2:CD006237.
    1. Arends I, Bruinvels DJ, Rebergen DS, Nieuwenhuijsen K, Madan I, Neumeyer-Gromen A, Bültmann U, Verbeek JH. Interventions to facilitate return to work in adults with adjustment disorders. Cochrane Libr. 2012;12:CD006389.
    1. Dewa CS, Loong D, Bonato S, Joosen MC. The effectiveness of return-to-work interventions that incorporate work-focused problem-solving skills for workers with sickness absences related to mental disorders: a systematic literature review. BMJ Open. 2015;5(6):e007122. doi: 10.1136/bmjopen-2014-007122.
    1. Pomaki G, Franche R-L, Murray E, Khushrushahi N, Lampinen TM. Workplace-based work disability prevention interventions for workers with common mental health conditions: a review of the literature. J Occup Rehabil. 2012;22(2):182–195. doi: 10.1007/s10926-011-9338-9.
    1. Karlson B, Jönsson P, Pålsson B, Åbjörnsson G, Malmberg B, Larsson B, Österberg K. Return to work after a workplace-oriented intervention for patients on sick-leave for burnout-a prospective controlled study. BMC Public Health. 2010;10(1):301. doi: 10.1186/1471-2458-10-301.
    1. 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(9):596–602. doi: 10.1136/oem.2009.050849.
    1. Lexis MA, Jansen NW, Huibers MJ, van Amelsvoort LG, Berkouwer A, Tjin ATG, van den Brandt PA, Kant I. Prevention of long-term sickness absence and major depression in high-risk employees: a randomised controlled trial. Occup Environ Med. 2011;68(6):400–407. doi: 10.1136/oem.2010.057877.
    1. Gartner FR, Nieuwenhuijsen K, Ketelaar SM, Van Dijk FJH, Sluiter JK. The mental vitality @ work study: effectiveness of a mental module for WorkersE health surveillance for nurses and allied health care professionals on their help-seeking behavior. J Occup Environ Med. 2013;55(10):1219–1229. doi: 10.1097/JOM.0b013e31829f310a.
    1. Grime PR. Computerized cognitive behavioural therapy at work: a randomized controlled trial in employees with recent stress-related absenteeism. Occup Med (Lond) 2004;54(5):353–359. doi: 10.1093/occmed/kqh077.
    1. Kant I, Jansen NW, van Amelsvoort LG, van Leusden R, Berkouwer A. Structured early consultation with the occupational physician reduces sickness absence among office workers at high risk for long-term sickness absence: a randomized controlled trial. J Occup Rehabil. 2008;18(1):79–86. doi: 10.1007/s10926-007-9114-z.
    1. Kilfedder C, Power K, Karatzias T, McCafferty A, Niven K, Chouliara Z, Galloway L, Sharp S. A randomized trial of face-to-face counselling versus telephone counselling versus bibliotherapy for occupational stress. Psychol Psychother. 2010;83(Pt 3):223–242. doi: 10.1348/147608309X476348.
    1. Peterson U, Bergstrom G, 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):506–516. doi: 10.1111/j.1365-2648.2008.04743.x.
    1. Nezu AM, Nezu CM, D'Zurilla TJ. Problem-Solving Therapy. A Treatment manual: New York. Springer Publishing Co Inc; 2013.
    1. Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52:397–422. doi: 10.1146/annurev.psych.52.1.397.
    1. van Oostrom SH, van Mechelen W, Terluin B, de Vet HC, Anema JR. A participatory workplace intervention for employees with distress and lost time: a feasibility evaluation within a randomized controlled trial. J Occup Rehabil. 2009;19(2):212–222. doi: 10.1007/s10926-009-9170-7.
    1. Axen I, Bodin L, Kongsted A, Wedderkopp N, Jensen I, Bergstrom G. Analyzing repeated data collected by mobile phones and frequent text messages. An example of low back pain measured weekly for 18 weeks. BMC Med Res Methodol. 2012;12:105. doi: 10.1186/1471-2288-12-105.
    1. Schutte N, Toppinen S, Kalimo R, Schaufeli W. The factorial validity of the Maslach Burnout Inventory-General Survey (MBI-GS) across occupational groups and nations. J Occup Organ Psychol. 2000;73:53–66. doi: 10.1348/096317900166877.
    1. Glise K, Hadzibajramovic E, Jonsdottir IH, Ahlborg G., Jr Self-reported exhaustion: a possible indicator of reduced work ability and increased risk of sickness absence among human service workers. Int Arch Occup Environ Health. 2010;83(5):511–520. doi: 10.1007/s00420-009-0490-x.
    1. 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. doi: 10.1016/S0022-3999(01)00296-3.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x.
    1. Elo A-L, Leppänen A, Jahkola A. Validity of a single-item measure of stress symptoms. Scand J Work Environ Health. 2003:444–51.
    1. Nordin M, Akerstedt T, Nordin S. Psychometric evaluation and normative data for the Karolinska Sleep questionnaire. Sleep Biol Rhythms. 2013;11(4):216–226. doi: 10.1111/sbr.12024.
    1. Björk S, Norinder A. The weighting exercise for the Swedish version of the EuroQol. Health Econ. 1999;8(2):117–126. doi: 10.1002/(SICI)1099-1050(199903)8:2<117::AID-HEC402>;2-A.
    1. Aronsson G, Gustafsson K, Dallner M. Sick but yet at work. An empirical study of sickness presenteeism. J Epidemiol Community Health. 2000;54(7):502–509. doi: 10.1136/jech.54.7.502.
    1. Tuomi K, Oja G. Work ability index. 1998.
    1. Lohela-Karlsson M, Bergström G, Björklund C, Hagberg J, Jensen I. Measuring production loss due to health and work environment problems: construct validity and implications. J Occup Environ Med. 2013;55(12):1475–1483. doi: 10.1097/JOM.0000000000000005.
    1. Reilly MC, Zbrozek AS, Dukes EM. The validity and reproducibility of a work productivity and activity impairment instrument. Pharmaco Economics. 1993;4(5):353–365. doi: 10.2165/00019053-199304050-00006.
    1. Aboagye E, Jensen I, Bergström G, Hagberg J, Axén I, Lohela-Karlsson M. Validity and test–retest reliability of an at-work production loss instrument. Occup Med. 2016; Advance Access published February 29, 2016
    1. Linton SJ, Halldén K. Can we screen for problematic back pain? A screening questionnaire for predicting outcome in acute and subacute back pain. Clin J Pain. 1998;14(3):209–215. doi: 10.1097/00002508-199809000-00007.
    1. Karasek R, Theorell T. Healthy work: stress, productivity, and the reconstruction of working life: basic books. 1992.
    1. Dallner M, Elo A-L, Gamberale F, Hottinen V, Knardahl S, Lindström K, Skogstad A, Orhede E. Validation of the general Nordic questionnaire (QPSNordic) for psychological and social factors at work. Nord 2000:12. Nordic Council of Ministers: Copenhagen; 2000.
    1. Tompa E, Culyer A, Dolinschi R. Editors. Economic evaluation of interventions for occupational health and safety. Developing good practice. Oxford: Oxford University Press; 2008.
    1. Ramsey S, Willke R, Briggs A, Brown R, Buxton M, Chawla A, Cook J, Glick H, Liljas B, Petitti D. Good research practices for cost-effectiveness analysis alongside clinical trials: the ISPOR RCT-CEA task force report. Value Health. 2005;8(5):521–533. doi: 10.1111/j.1524-4733.2005.00045.x.
    1. Hulshof CT, Verbeek JH, van Dijk FJ, van der Weide WE, Braam IT. Evaluation research in occupational health services: general principles and a systematic review of empirical studies. Occup Environ Med. 1999;56(6):361–377. doi: 10.1136/oem.56.6.361.
    1. Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, Moore L, O'Cathain A, Tinati T, Wight D, Baird J. Process evaluation of complex interventions: Medical Research Council guidance. BMJ. 2015;350:h1258. doi: 10.1136/bmj.h1258.
    1. Axen I, Bodin L, Bergstrom G, Halasz L, Lange F, Lovgren PW, Rosenbaum A, Leboeuf-Yde C, Jensen I. The use of weekly text messaging over 6 months was a feasible method for monitoring the clinical course of low back pain in patients seeking chiropractic care. J Clin Epidemiol. 2012;65(4):454–461. doi: 10.1016/j.jclinepi.2011.07.012.
    1. Stenlund T, Ahlgren C, Lindahl B, Burell G, Steinholtz K, Edlund C, Nilsson L, Knutsson A, Birgander LS. Cognitively oriented behavioral rehabilitation in combination with qigong for patients on long-term sick leave because of burnout: REST—a randomized clinical trial. Int J Behav Med. 2009;16(3):294–303. doi: 10.1007/s12529-008-9011-7.
    1. Perski A. Rehabilitation of stress-related diseases goes on different phases and is often long-lasting. Lakartidningen. 2004;101(14):1292–1294.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir