Prevention of sick leave at the workplace: design of a cluster-randomized controlled trial of a problem-solving intervention among employees with common mental disorders

E Björk Brämberg, B Arapovic-Johansson, U Bültmann, P Svedberg, G Bergström, E Björk Brämberg, B Arapovic-Johansson, U Bültmann, P Svedberg, G Bergström

Abstract

Background: Common mental disorders are highly prevalent in the working population, affecting about 1 in 5 persons in the Organisation for Economic Co-operation and Development countries. About 30% of those affected have a first period of sick leave. Despite several attempts to reduce the risk of sick leave among employees with common mental disorders, there is a lack of knowledge about effective, preventive interventions which aim to reduce such risks. This protocol describes the design of a study to evaluate the effectiveness of a problem-solving intervention delivered by first-line managers to employees with common mental disorders on the prevention of sick leave during the 12-month follow-up.

Methods/design: The study applies a two-armed cluster-randomized trial design of a problem-solving intervention conducted in private-sector companies. First-line managers are randomized into intervention- or control groups by computer-generated random numbers, allocation ratio 1:1. Employees are eligible if at risk for future sick leave due to common mental disorders. These are identified by self-reported psychological health measured by the General Health Questionnaire 12-item, cut-off ≥3, or a positive answer to risk of sick leave. The intervention is based on problem-solving principles. It involves the training of the first-line managers who then deliver the intervention to employees identified at risk of sick leave. First-line managers in the control group receives a lecture. Primary outcome is number of registered days of sick leave due to common mental disorders during the 12-month follow-up. Secondary outcomes are general health, psychological symptoms, work performance, work ability and psychosocial work environment. A process evaluation will examine the intervention's reach, fidelity, dose delivered, dose received, satisfaction and context. Research assistants managing the screening procedure, outcome assessors and employees are blinded to randomization and allocation.

Discussion: The study includes analyses of the intervention's effectiveness and an alongside process evaluation. Methodological strengths and limitations, for example the risk of selection bias, attrition and risk of contamination are discussed.

Trial registration: Clinicaltrials.gov NCT04975750 Date of registration: 08/16/2021.

Keywords: Adjustment disorder; Anxiety disorder; Blue-collar worker; Cluster-randomized controlled trial; Common mental disorder; Depression; Manager; Prevention; Problem solving; Sick leave.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flowchart and overview of the trial
Fig. 2
Fig. 2
The problem-solving intervention’s program theory with the intervention’s core activities, expected changes and outcomes on organizational and individual levels

References

    1. OECD. Fit Mind, Fit Job: From Evidence to Practice in Mental Health and Work, Mental Health and Work. Paris: OECD Publishing; 2015. 10.1787/9789264228283-en.
    1. OECD/European Union. Health at a Glance: Europe 2018: State of Health in the EU Cycle. Paris/European Union, Brussels: OECD Publishing; 2018. 10.1787/health_glance_eur-2018-en.
    1. Steel Z, Marnane C, Iranpour C, Chey T, Jackson JW, Patel V, Silove D. The global prevalence of common mental disorders: a systematic review and meta-analysis 1980-2013. Int J Epidemiol. 2014;43(2):476–493. doi: 10.1093/ije/dyu038.
    1. de Vries H, Fishta A, Weikert B, Rodriguez Sanchez A, Wegewitz U. Determinants of sickness absence and return to work among employees with common mental disorders: a scoping review. J Occup Rehabil. 2018;28(3):393–417. doi: 10.1007/s10926-017-9730-1.
    1. Modini M, Joyce S, Mykletun A, Christensen H, Bryant RA, Mitchell PB, Harvey SB. The mental health benefits of employment: results of a systematic meta-review. Australas Psychiatry. 2016;24(4):331–336. doi: 10.1177/1039856215618523.
    1. Schuring M, Robroek SJ, Burdorf A. The benefits of paid employment among persons with common mental health problems: evidence for the selection and causation mechanism. Scand J Work Environ Health. 2017;43(6):540–549. doi: 10.5271/sjweh.3675.
    1. van der Noordt M, IJzenlenberg H, Droomers M, Proper KI. Health effects of employment: a systematic review of prospective studies. Occup Environ Med. 2014;71(10):730–736. doi: 10.1136/oemed-2013-101891.
    1. Marmot M. Social justice, epidemiology and health inequalities. Eur J Epidemiol. 2017;32(7):537–546. doi: 10.1007/s10654-017-0286-3.
    1. OECD . Sick on the job? Myths and realities about mental health and work. Paris: OECD Publishing; 2012.
    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. Axén I, Björk Brämberg E, Vaez M, Lundin A, Bergström G. Interventions for common mental disorders in the occupational health service: a systematic review with a narrative synthesis. Int Arch Occup Environ Health. 2020;93(7):823–838. doi: 10.1007/s00420-020-01535-4.
    1. Nieuwenhuijsen K, Verbeek JH, Neumeyer-Gromen A, Verhoeven AC, Bültmann U, Faber B. Interventions to improve return to work in depressed people. Cochrane Database Syst Rev. 2020;10:Cd006237.
    1. van Vilsteren M, van Oostrom SH, de Vet HC, Franche RL, Boot CR, Anema JR. Workplace interventions to prevent work disability in workers on sick leave. Cochrane Database Syst Rev. 2015;(10):CD006955. 10.1002/14651858.CD006955.pub3.
    1. Keus van de Poll M, Nybergh L, Lornudd C, Hagberg J, Bodin L, Kwak L, Jensen I, Lohela-Karlsson M, Torgén M, Bergstrom G. 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. Occup Environ Med. 2020;77(7):454–461. doi: 10.1136/oemed-2019-106353.
    1. Arends I, van der Klink JJ, van Rhenen W, de Boer MR, Bultmann U. Prevention of recurrent sickness absence in workers with common mental disorders: results of a cluster-randomised controlled trial. Occup Environ Med. 2014;71(1):21–29. doi: 10.1136/oemed-2013-101412.
    1. Arends I, Bruinvels DJ, Rebergen DS, Nieuwenhuijsen K, Madan I, Neumeyer-Gromen A, Bultmann U, Verbeek JH. Interventions to facilitate return to work in adults with adjustment disorders. Cochrane Database Syst Rev. 2012;12:CD006389. doi: 10.1002/14651858.CD006389.pub2.
    1. Kraaijeveld RA, Schaafsma FG, Boot CR, Shaw WS, Bültmann U, Anema JR. Implementation of the participatory approach to increase supervisors’ self-efficacy in supporting employees at risk for sick leave; design of a randomised controlled trial. BMC Public Health. 2013;13(1):750. doi: 10.1186/1471-2458-13-750.
    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. Ketelaar SM, Schaafsma FG, Geldof MF, Kraaijeveld RA, Boot CRL, Shaw WS, Bültmann U, Anema JR. Implementation of the participatory approach for supervisors to increase self-efficacy in addressing risk of sick leave of employees: results of a cluster-randomized controlled trial. J Occup Rehabil. 2017;27(2):247–257. doi: 10.1007/s10926-016-9652-3.
    1. Vlasveld MC, van der Feltz-Cornelis CM, Adèr HJ, Anema JR, Hoedeman R, van Mechelen W, Beekman AT. Collaborative care for major depressive disorder in an occupational healthcare setting. Br J Psychiatry. 2012;200(6):510–511. doi: 10.1192/bjp.bp.111.095687.
    1. Rugulies R. What is a psychosocial work environment? Scand J Work Environ Health. 2019;45(1):1–6. doi: 10.5271/sjweh.3792.
    1. Theorell T, Hammarström A, Aronsson G, Träskman Bendz L, Grape T, Hogstedt C, Marteinsdottir I, Skoog I, Hall C. A systematic review including meta-analysis of work environment and depressive symptoms. BMC Public Health. 2015;15(1):738. doi: 10.1186/s12889-015-1954-4.
    1. Aronsson G, Theorell T, Grape T, Hammarström A, Hogstedt C, Marteinsdottir I, Skoog I, Träskman-Bendz L, Hall C. A systematic review including meta-analysis of work environment and burnout symptoms. BMC Public Health. 2017;17(1):264. doi: 10.1186/s12889-017-4153-7.
    1. Moher D, Hopewell S, Schulz KF, Montori V, Gotzsche PC, Devereaux PJ, Elbourne D, Egger M, Altman DG. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol. 2010;63(8):e1–37. doi: 10.1016/j.jclinepi.2010.03.004.
    1. Campbell MK, Piaggio G, Elbourne DR, Altman DG. Consort 2010 statement: extension to cluster randomised trials. BMJ. 2012;345(sep04 1):e5661. doi: 10.1136/bmj.e5661.
    1. Lundin A, Hallgren M, Theobald H, Hellgren C, Torgén M. Validity of the 12-item version of the general health questionnaire in detecting depression in the general population. Public Health. 2016;136:66–74. doi: 10.1016/j.puhe.2016.03.005.
    1. Goldberg DP, Gater R, Sartorius N, Ustun TB, Piccinelli M, Gureje O, Rutter C. The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med. 1997;27(1):191–197. doi: 10.1017/S0033291796004242.
    1. Lundin A, Dalman C. Psykisk ohälsa mätt med the General Health Questionnaire. En validering i Stockholms län. Stockholm: Centrum för epidemiologi och samhällsmedicin, Stockholms läns landsting; 2020.
    1. Jensen IB, Bodin L, Ljungqvist T, Gunnar Bergstrom K, Nygren A. Assessing the needs of patients in pain: a matter of opinion? Spine (Phila Pa 1976) 2000;25(21):2816–2823. doi: 10.1097/00007632-200011010-00015.
    1. Nezu A, Nezu C, D’Zurilla T. Problem-solving therapy. A Treatment manual. New York: Springer Publishing Co Inc; 2013.
    1. Forsetlund L, Bjørndal A, Rashidian A, Jamtvedt G, O'Brien MA, Wolf F, Davis D, Odgaard-Jensen J, Oxman AD. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2009;2009(2):Cd003030.
    1. Björk Brämberg E, Holmgren K, Bultmann U, Gyllensten H, Hagberg J, Sandman L, Bergstrom G. Increasing return-to-work among people on sick leave due to common mental disorders: design of a cluster-randomized controlled trial of a problem-solving intervention versus care-as-usual conducted in the Swedish primary health care system (PROSA) BMC Public Health. 2018;18(1):889. doi: 10.1186/s12889-018-5816-8.
    1. Hargie O. The handbook of communication skills. 4. New York: Routhledge; 2019.
    1. Linehan M. Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford press; 1993.
    1. Koerner K, Dimeff L. Overview of dialectical behavior therapy. In: Dimeff L, Koerner K, editors. Dialectical behavior therapy in clinical practice: applications across disorders and settings. New York: Guilford press; 2007.
    1. Sturrock B, Holloway E, Keefe J, Hegel M, Casten R, Mellor D, Rees G. Rehabilitation staff perspectives on training for problem-solving therapy for primary care in a low vision service. Br J Visual Impairment. 2016;34(1):26–41. doi: 10.1177/0264619615610159.
    1. Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52(1):397–422. doi: 10.1146/annurev.psych.52.1.397.
    1. Ludvigsson JF, Svedberg P, Olén O, Bruze G, Neovius M. The longitudinal integrated database for health insurance and labour market studies (LISA) and its use in medical research. Eur J Epidemiol. 2019;34(4):423–437. doi: 10.1007/s10654-019-00511-8.
    1. Burström B, Fredlund P. Self rated health: is it as good a predictor of subsequent mortality among adults in lower as well as in higher social classes? J Epidemiol Community Health. 2001;55(11):836–840. doi: 10.1136/jech.55.11.836.
    1. Lisspers J, Nygren A, Soderman E. Hospital anxiety and depression scale (HAD): some psychometric data for a Swedish sample. Acta Psychiatr Scand. 1997;96(4):281–286. doi: 10.1111/j.1600-0447.1997.tb10164.x.
    1. Andrea H, Bültmann U, Beurskens AJ, Swaen GM, van Schayck CP, Kant IJ. Anxiety and depression in the working population using the HAD scale--psychometrics, prevalence and relationships with psychosocial work characteristics. Soc Psychiatry Psychiatr Epidemiol. 2004;39(8):637–646. doi: 10.1007/s00127-004-0797-6.
    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. Arapovic-Johansson B, Wåhlin C, Kwak L, Björklund C, Jensen I. Work-related stress assessed by a text message single-item stress question. Occup Med (Lond) 2017;67(8):601–608. doi: 10.1093/occmed/kqx111.
    1. Karlsson ML, Bergstrom G, Bjorklund 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. Pharmacoeconomics. 1993;4(5):353–365. doi: 10.2165/00019053-199304050-00006.
    1. Aboagye E, Jensen I, Bergstrom G, Hagberg J, Axen I, Lohela-Karlsson M. Validity and test-retest reliability of an at-work production loss instrument. Occup Med (Lond) 2016;66(5):377–382. doi: 10.1093/occmed/kqw021.
    1. Eskelinen L, Kohvakka A, Merisalo T, Hurri H, Wagar G. Relationship between the self-assessment and clinical assessment of health status and work ability. Scand J Work Environ Health. 1991;17(Suppl 1):40–47.
    1. Berthelsen H, Westerlund H, Bergström G, Burr H. Validation of the Copenhagen Psychosocial Questionnaire Version III and Establishment of Benchmarks for Psychosocial Risk Management in Sweden. Int J Environ Res Public Health. 2020;17(9). 10.3390/ijerph17093179.
    1. Dallner M, Lindström K, Elo A-L, Skogstad A, Gamberale F, Hottinen V, Knardahl S, Örhede E. Användarmanual för QPSNordic. Frågeformulär om psykologiska och sociala faktorer i arbetslivet utprovat i Danmark, Finland, Norge och Sverige. Stockholm: Arbetslivsinstitutet; 2000.
    1. Netemeyer R, Boles J, McMurrian R. Development and validation of workfamily conflict and family-work conflict scales. J Appl Psychol. 1996;81(4):400–410. doi: 10.1037/0021-9010.81.4.400.
    1. Love J, Moore CD, Hensing G. Validation of the Swedish translation of the general self-efficacy scale. Qual Life Res. 2012;21(7):1249–1253. doi: 10.1007/s11136-011-0030-5.
    1. Williams G, Smith A. Using single-item measures to examine the relationships between work, personality, and well-being in the workplace. Psychology. 2016;7(6):753–767. doi: 10.4236/psych.2016.76078.
    1. Dollard MF, Bakker AB. Psychosocial safety climate as a precursor to conducive work environments, psychological health problems, and employee engagement. J Occup Organ Psychol. 2010;83(3):579–599. doi: 10.1348/096317909X470690.
    1. Berthelsen H, Muhonen T. Psykosocialt säkerhetsklimat – ett sätt att mäta organisatoriskt och socialt säkerhetsklimat. Stockholm: Stressforskningsinstitutet; 2017.
    1. Berthelsen H, Muhonen T, Bergström G, Westerlund H, Dollard MF. Benchmarks for Evidence-Based Risk Assessment with the Swedish Version of the 4-Item Psychosocial Safety Climate Scale. Int J Environ Res Public Health. 2020;17(22). 10.3390/ijerph17228675.
    1. Heppner P, Witty T, Dixon W. Problem-solving appraisal and human adjustment: a review of 20 years of research using the problem solving inventory. Couns Psychol. 2004;32(3):344–428. doi: 10.1177/0011000003262793.
    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(mar19 6):h1258. doi: 10.1136/bmj.h1258.
    1. Linnan L, Steckler A. Process evaluation for public health interventions and research. San Francisco: Jossey-Bass; 2002.
    1. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4(1):50. doi: 10.1186/1748-5908-4-50.
    1. Kirk MA, Kelley C, Yankey N, Birken SA, Abadie B, Damschroder L. A systematic review of the use of the consolidated framework for implementation research. Implement Sci. 2016;11(1):72. doi: 10.1186/s13012-016-0437-z.
    1. Nagin DS, Odgers CL. Group-based trajectory modeling in clinical research. Annu Rev Clin Psychol. 2010;6(1):109–138. doi: 10.1146/annurev.clinpsy.121208.131413.
    1. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–112. doi: 10.1016/j.nedt.2003.10.001.
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. doi: 10.1191/1478088706qp063oa.
    1. Ayres J, Malouff JM. Problem-solving training to help workers increase positive affect, job satisfaction, and life satisfaction. Eur J Work Organ Psychol. 2007;16(3):279–294. doi: 10.1080/13594320701391804.
    1. Bowling NA, Eschleman KJ, Wang Q. A meta-analytic examination of the relationship between job satisfaction and subjective well-being. J Occup Organ Psychol. 2010;83(4):915–934. doi: 10.1348/096317909X478557.
    1. Headey B, Kelley J, Wearing A. Dimensions of mental health: life satisfaction, positive affect, anxiety and depression. Soc Indic Res. 1993;29(1):63–82. doi: 10.1007/BF01136197.
    1. Wierenga D, Engbers LH, Van Empelen P, Duijts S, Hildebrandt VH, Van Mechelen W. What is actually measured in process evaluations for worksite health promotion programs: a systematic review. BMC Public Health. 2013;13(1):1190. doi: 10.1186/1471-2458-13-1190.
    1. Havermans BM, Schlevis RM, Boot CR, Brouwers EP, Anema J, van der Beek AJ. Process variables in organizational stress management intervention evaluation research: a systematic review. Scand J Work Environ Health. 2016;42(5):371–381. doi: 10.5271/sjweh.3570.
    1. van den Berg TI, Robroek SJ, Plat JF, Koopmanschap MA, Burdorf A. The importance of job control for workers with decreased work ability to remain productive at work. Int Arch Occup Environ Health. 2011;84(6):705–712. doi: 10.1007/s00420-010-0588-1.
    1. Swedish work environment authority . AFS 2015. Solna: Swedish work environment authority; 2015. Organisational and social work environment, provisions.

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