Integrated mental health care and vocational rehabilitation to improve return to work rates for people on sick leave because of exhaustion disorder, adjustment disorder, and distress (the Danish IBBIS trial): study protocol for a randomized controlled trial

Rie Poulsen, Jonas Fisker, Andreas Hoff, Carsten Hjorthøj, Lene Falgaard Eplov, Rie Poulsen, Jonas Fisker, Andreas Hoff, Carsten Hjorthøj, Lene Falgaard Eplov

Abstract

Background: Common mental disorders are important contributors to the global burden of disease and cause negative effects on both the individual and society. Stress-related disorders influence the individual's workability and cause early retirement pensions in Denmark. There is no clear evidence that mental health care alone will provide sufficient support for vocational recovery for this group. Integrated vocational and health care services have shown good effects on return to work in other similar welfare contexts. The purpose of the Danish IBBIS (Integreret Behandlings- og BeskæftigelsesIndsats til Sygemeldte) study is to examine the efficacy of (1) a stepped mental health care intervention with individual stress coaching and/or group-based MBSR and (2) an integrated stepped mental health care with individual stress coaching and/or group-based MBSR and vocational rehabilitation intervention for people on sick leave because of exhaustion disorder, adjustment disorder or distress in Denmark.

Method/design: This three-armed, parallel-group, randomized superiority trial is set up to investigate the effectiveness of a stepped mental health care intervention and an integrated mental health care and vocational rehabilitation intervention for people on sick leave because of exhaustion disorder, adjustment disorder or distress in Denmark. The trial has an investigator-initiated multicenter design. Six hundred and three patients will be recruited from Danish vocational rehabilitation centers in four municipalities and randomly assigned into three groups: (1) IBBIS mental health care integrated with IBBIS vocational rehabilitation, (2) IBBIS mental health care and standard vocational rehabilitation, and (3) standard mental health care and standard vocational rehabilitation. The primary outcome is register-based return to work at 12 months. The secondary outcome measures are self-assessed level of depression (BDI), anxiety (BAI), distress symptoms (4DSQ), work- and social functioning (WSAS), and register-based recurrent sickness absence.

Discussion: This study will contribute with knowledge on the consequence of the current organizational separation of health care interventions and vocational rehabilitation regarding the individual's process of returning to work after sick leave because of exhaustion disorder, adjustment disorder or distress. If the effect on return to work, symptom level, and recurrent sick leave is different in the intervention groups, this study can contribute with new knowledge on shared care models and the potential for preventing deterioration in stress symptoms, prolonged sick leave, and recurrent sick leave.

Trial registration: ClinicalTrials.gov, registration number: NCT02885519 . Retrospectively registered on 15 August 2016). Participants have been included in the IBBIS trial for distress, adjustment disorder and exhaustion disorder since April 2016.

Keywords: Adjustment disorder; Distress; Exhaustion disorder; Integrated services; MBSR; Prevention of recurrent sickness absence; RCT; Return to work; Stress coaching; Vocational rehabilitation.

Conflict of interest statement

Ethics approval and consent to participate

The trial has been evaluated by the Regional Ethics Committees of the Capital Region (# H-16015724), but the trial was not judged to be a biomedical trial and the need for ethical approval was, therefore, not necessary. The protocol is registered on www.clinicaltrials.gov (# NCT02885519), and any changes in inclusion criteria or intervention will be submitted to the website. The Danish Data Protection Agency has approved the project (#RHP-2016-006), and it will be conducted in accordance with applicable regulations.

Every participant in the trial has been informed about the objective of the study, and the implications of participation by an IBBIS team member and has given oral and written consent to participate before enrollment. Participants will be informed about their rights to withdraw from the study at any point and without consequences for their future treatment. If withdrawing, participants can decide if their information, and how much of their information, can be used in the study.

Interventions similar to the IBBIS interventions have not previously shown adverse effects. Symptom severity and suicidal ideation are nonetheless monitored by care managers to make sure that deterioration in the participant’s condition can be accommodated. After the intervention phase has ended, we will evaluate on negative effects such as suicide, recurrent sick leave, death of any cause and symptom increase at 6-, 12-, and 24-month follow-up. Starting work will be stressful for some participants. If return to work takes place during the intervention period, this will be monitored closely by the involved IBBIS team member.

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
Flow chart for IBBIS participants

References

    1. Nielsen MBD, Bültmann U, Amby M, Christensen U, Diderichsen F, Rugulies R. Return to work among employees with common mental disorders: study design and baseline findings from a mixed-method follow-up study. Scand J Public Health. 2010;38:864–72. doi: 10.1177/1403494810384424.
    1. Arends I, Bruinvels DJ, Rebergen DS, Nieuwenhuijsen K, Madan I, Neumeyer-Gromen A, et al. Interventions to facilitate return to work in adults with adjustment disorders. Cochrane Database Syst Rev. 2012;12:CD006389.
    1. Søgaard HJ, Bech P. Psychiatric disorders in long-term sickness absence—a population-based cross-sectional study. Scand J Public Health. 2009;37:682–9. doi: 10.1177/1403494809344357.
    1. Eriksson U, Starrin B, Janson S. Long-term sickness absence due to burnout: absentees’ experiences. Qual Health Res. 2008;18:620–32. doi: 10.1177/1049732308316024.
    1. Terluin B, van Marwijk HWJ, Adèr HJ, de Vet HCW, Penninx BWJH, Hermens MLM, et al. The Four-Dimensional Symptom Questionnaire (4DSQ): a validation study of a multidimensional self-report questionnaire to assess distress, depression, anxiety and somatization. BMC Psychiatry. 2006;6:34. doi: 10.1186/1471-244X-6-34.
    1. Wang J. Work stress as a risk factor for major depressive episode(s) Psychol Med. 2005;35:865–71. doi: 10.1017/S0033291704003241.
    1. Wang JL, Lesage A, Schmitz N, Drapeau A. The relationship between work stress and mental disorders in men and women: findings from a population-based study. J Epidemiol Community Health. 2008;62:42–7. doi: 10.1136/jech.2006.050591.
    1. Henderson M, Glazier N, Elliott KH. Long term sickness absence: is caused by common conditions and needs managing. BMJ. 2005;330:802–3. doi: 10.1136/bmj.330.7495.802.
    1. OECD. Mental health and work: Denmark. OECD Publishing; 2013. .
    1. Harvey SB, Henderson M, Lelliott P, Hotopf M. Mental health and employment: much work still to be done. Br J Psychiatry. 2009;194:201–3. doi: 10.1192/bjp.bp.108.055111.
    1. Koopmans PC, Bultmann U, Roelen CAM, Hoedeman R, van der Klink JJL, Groothoff JW. Recurrence of sickness absence due to common mental disorders. Int Arch Occup Environ Health. 2011;84:193–201. doi: 10.1007/s00420-010-0540-4.
    1. Flachs EM, Eriksen L, Koch MB, Ryd JT, Dibba E, Skov-Ettrup L, Juel K. Statens Institut for Folke- sundhed, Syddansk Universitet. Sygdomsbyrden i Danmark – sygdomme. København: Sundhedsstyrelsen; 2015.
    1. Olsen IB, Overland S, Reme SE, Lovvik C. Exploring work-related causal attributions of common mental disorders. J Occup Rehabil. 2014;493–505. doi:10.1007/s10926-014-9556-z.
    1. Hjarsbech PU, Nielsen MBD, Andersen MF, Rugulies R, Christensen U. Struggling at work—a qualitative study of working Danes with depressive symptoms. Disabil Rehabil. 2014;0:1–9. doi:10.3109/09638288.2014.973970.
    1. Ervasti H, Venetoklis T. Unemployment and Subjective Well-being: an empirical test of deprivation theory, incentive paradigm and financial strain approach. Acta Sociol. 2010;53:119–39. doi: 10.1177/0001699310365624.
    1. Grove B, Secker J, Seebohm P. New thinking about mental health and employment. Oxford: Radcliffe; 2005.
    1. Wanberg CR. The individual experience of unemployment. Annu Rev Psychol. 2012;63:369–96. doi: 10.1146/annurev-psych-120710-100500.
    1. Paul KI, Moser K. Unemployment impairs mental health: meta-analyses. J Vocat Behav. 2009;74:264–82. doi: 10.1016/j.jvb.2009.01.001.
    1. Henderson M, Harvey SB, Overland S, Mykletun A, Hotopf M. Work and common psychiatric disorders. J R Soc Med. 2011;104:198–207. doi: 10.1258/jrsm.2011.100231.
    1. Nigatu YT, Liu Y, Uppal M, McKinney S, Rao S, Gillis K, et al. Interventions for enhancing return to work in individuals with a common mental illness: systematic review and meta-analysis of randomized controlled trials. Psychol Med. 2016;1–12. doi:10.1017/S0033291716002269.
    1. Netterstrøm B, Friebel L, Ladegaard Y. Effects of a multidisciplinary stress treatment programme on patient return to work rate and symptom reduction: results from a randomised, wait-list controlled trial. Psychother Psychosom. 2013;82:177–86. doi: 10.1159/000346369.
    1. Andersen MF, Nielsen KM, Brinkmann S. Meta-synthesis of qualitative research on return to work among employees with common mental disorders. Scand J Work Environ Health. 2012;38:93–104. doi: 10.5271/sjweh.3257.
    1. Nielsen MBD, Bültmann U, Madsen IEH, Martin M, Christensen U, Diderichsen F, et al. Health, work, and personal-related predictors of time to return to work among employees with mental health problems. Disabil Rehabil. 2012;34:1311–6. doi: 10.3109/09638288.2011.641664.
    1. Hees HL, Koeter MWJ, Schene AH. Predictors of long-term return to work and symptom remission in sick-listed patients with major depression. J Clin Psychiatry. 2012;73:1048–55. doi: 10.4088/JCP.12m07699.
    1. Dunstan DA, MacEachen E. Bearing the brunt: co-workers’ experiences of work reintegration processes. J Occup Rehabil. 2013;23:44–54. doi: 10.1007/s10926-012-9380-2.
    1. Kinoshita Y, Ta F, Kinoshita K, Honyashiki M, Im O, Marshall M, et al. Supported employment for adults with severe mental illness. Cochrane Database Syst Rev. 2013;(9):CD008297.
    1. Bejerholm U, Areberg C, Hofgren C, Sandlund M, Rinaldi M. Individual placement and support in Sweden—a randomized controlled trial. Nord J Psychiatry. 2015;69:57–66. doi: 10.3109/08039488.2014.929739.
    1. Reme SE, Grasdal AL, Løvvik C, Lie SA, Øverland S. Work-focused cognitive-behavioural therapy and individual job support to increase work participation in common mental disorders: a randomised controlled multicentre trial. Occup Environ Med. 2015;oemed-2014-102700. doi:10.1136/oemed-2014-102700.
    1. Mehlsen L, Holt H, Bach HB, Thörnfeldt C. Ressourceforløb. Koordinerende sagsbehandleres og borgeres erfaringer. København: SFI Det Nationale Forskningscenter for Velfærd; 2015.
    1. Mikkelsgård KA, Granerud A, Høye S. People with mental illness returning to work: a qualitative evaluation of a Norwegian project. Scand J Occup Ther. 2014;21:172–80. doi: 10.3109/11038128.2014.882981.
    1. Chan A-W, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, Krleža-Jerić K, et al. SPIRIT 2013 Statement: Defining Standard Protocol Items for Clinical Trials. Ann Intern Med. 2013;158:200. doi: 10.7326/0003-4819-158-3-201302050-00583.
    1. Boutron I, Moher D, Altman D. Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern. 2008;148(4):295–310.
    1. Besèr A, Sorjonen K, Wahlberg K, Peterson U, Nygren A, Asberg M. Construction and evaluation of a self rating scale for stress-induced exhaustion disorder, the Karolinska Exhaustion Disorder Scale. Scand J Psychol. 2014;55:72–82. doi: 10.1111/sjop.12088.
    1. World Health Organization The ICD-10 Classification of Mental and Behavioural Disorders. Int Classif. 1992;10:1–267.
    1. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(Suppl 2):22–33.
    1. Cole MG, McCusker J, Elie M, Dendukuri N, Latimer E, Belzile E. Systematic detection and multidisciplinary care of depression in older medical inpatients: a randomized trial. Can Med Assoc J. 2006;174:38–44. doi:10.1503/cmaj.050519.
    1. Moran P, Leese M, Lee T, Walters P, Thornicroft G, Mann A. Standardised Assessment of Personality – Abbreviated Scale (SAPAS): preliminary validation of a brief screen for personality disorder. Br J Psychiatry. 2003;183:228–32. doi: 10.1192/bjp.183.3.228.
    1. Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E, et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med. 2005;35:245–56. doi: 10.1017/S0033291704002892.
    1. Nielsen MBD, Madsen IEH, Bültmann U, Christensen U, Diderichsen F, Rugulies R. Predictors of return to work in employees sick-listed with mental health problems: findings from a longitudinal study. Eur J Public Health. 2011;21:806–11. doi: 10.1093/eurpub/ckq171.
    1. Kabat-Zinn J. Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. 2nd edition. London: Piatkus; 2013.
    1. Franche RL, Krause N. Readiness for return to work following injury or illness: conceptualizing the interpersonal impact of health care, workplace, and insurance factors. Handb Complex Occup Disabil Claims Early Risk Identification, Interv Prev. 2005;12:67–91.
    1. Abma FI, Van Der Klink JJL, Bültmann U. The Work Role Functioning Questionnaire 2.0 (Dutch Version): examination of its reliability, validity and responsiveness in the general working population. J Occup Rehabil. 2013;23:135–47. doi: 10.1007/s10926-012-9379-8.
    1. Shaw WS, Reme SE, Linton SJ, Huang YH, Pransky G. 3rd place, PREMUS 1 best paper competition: development of the return-to-work self-efficacy (RTWSE-19) questionnaire – psychometric properties and predictive validity. Scand J Work Environ Health. 2011;37:109–19. doi: 10.5271/sjweh.3139.
    1. van der Klink JJ, Ausems CMM, Beijderwellen BD, Blonk R, Bruinvels DJ, Dogger J. Richtlijn: handelen van de bedrijfsarts bij werkenden met psychische problemen. Utrecht: Nederlands Vereniging voor Arbeids-en Bedrijfsgeneeskunde (NVAB); 2007.
    1. Arends I, van der Klink JJL, van Rhenen W, de Boer MR, Bültmann U. Prevention of recurrent sickness absence in workers with common mental disorders: results of a cluster-randomised controlled trial. Occup Environ Med. 2014;71:21–9. doi: 10.1136/oemed-2013-101412.
    1. Burns T, Catty J, Becker T, Drake RE, Fioritti A, Knapp M, et al. The effectiveness of supported employment for people with severe mental illness: a randomised controlled trial. Lancet. 2007;370:1146–52. doi: 10.1016/S0140-6736(07)61516-5.
    1. Gittell JH, Weinberg D, Pfefferle S, Bishop C. Impact of relational coordination on job satisfaction and quality outcomes: A study of nursing homes. Hum Resour Manag J. 2008;18:154–70
    1. Nielsen L, Curtis T, Grønbaek M, Nielsen NR. Forebyggelse og behandling af stress i Danmark. Copenhagen: Forebyggelse og behandling af stress i Danmark; 2007.
    1. Region Sjælland. Samtaleterapi i almen praksis. En analyse i almen praksis. 2016.
    1. Komiteen for Sundhedsoplysning. Lær at tackle status i Danmark. . 2017. .
    1. Danish Agency for Labour Market and Recruitment. The DREAM database, statistics Denmark. DREAM databasen. 2016. . Accessed 21 Dec 2016.
    1. Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory-II. San Antonio: TX Psychol Corp; 1996. pp. 1–82.
    1. Osman A, Hoffman J, Barrios FX, Kopper BA, Breitenstein JL, Hahn SK. Factor structure, reliability, and validity of the beck anxiety inventory in adolescent psychiatric inpatients. J Clin Psychol. 2002;58:443–56. doi: 10.1002/jclp.1154.
    1. Wang YP, Gorenstein C. Psychometric properties of the Beck Depression Inventory-II: a comprehensive review. Rev Bras Psiquiatr. 2013;35:416–31. doi: 10.1590/1516-4446-2012-1048.
    1. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56:893–7. doi: 10.1037/0022-006X.56.6.893.
    1. Lee E-H. Review of the psychometric evidence of the perceived stress scale. Asian Nurs Res (Korean Soc Nurs Sci) 2012;6:121–7. doi: 10.1016/j.anr.2012.08.004.
    1. Mundt JC, Marks IM, Shear MK, Greist JH. The Work and Social Adjustment Scale: a simple measure of impairment in functioning. Br J Psychiatry. 2002;180:461–4. doi: 10.1192/bjp.180.5.461.
    1. Saboonchi F, Perski A, Grossi G. Validation of Karolinska Exhaustion Scale: psychometric properties of a measure of exhaustion syndrome. Scand J Caring Sci. 2013;27:1010–7. doi: 10.1111/j.1471-6712.2012.01089.x.
    1. The Swedish National Board of Health and Welfare. Exhaustion disorder. 2003.
    1. Turner N, Campbell J, Peters TJ, Wiles N, Hollinghurst S. A comparison of four different approaches to measuring health utility in depressed patients. Health Qual Life Outcomes. 2013;11:81. doi: 10.1186/1477-7525-11-81.
    1. Burckhardt CS, Anderson KL. The Quality of Life Scale (QOLS): reliability, validity, and utilization. Health Qual Life Outcomes. 2003;1:60. doi: 10.1186/1477-7525-1-60.
    1. Moss-Morris R, Weinman J, Petrie KJ, Horne R, Cameron LD, Buick D. The revised Illness Perception Questionnaire (IPQ-R) Psychol Health. 2002;17:1–16. doi: 10.1080/08870440290001494.
    1. Lagerveld SE, Blonk RWB, Brenninkmeijer V, Schaufeli WB. Return to work among employees with mental health problems: development and validation of a self-efficacy questionnaire. Work Stress. 2010;24:359–75. doi: 10.1080/02678373.2010.532644.
    1. Schwarzer R, Jerusalem M. Generalized Self-Efficacy scale. In: Wright S, Johnston M, editors. Measures in health psychology: a user’s portfolio. Causal and control beliefs. Windsor: Generalized Self-Efficacy scale; 1995. p. 35–7.
    1. Attkisson C, Zwick R. The Client Satisfaction Questionnaire: psychometric properties and correlations with service utilization and psychotherapy outcome. Eval Program Plann. 1982;5:233–7. doi: 10.1016/0149-7189(82)90074-X.
    1. Johns G. Presenteeism in the workplace: a review and research agenda. J Organ Behav. 2010;31:519–42. doi: 10.1002/job.630.
    1. Van Oostrom SH, Van Mechelen W, Terluin B, De Vet HCW, Knol DL, Anema JR. A workplace intervention for sick-listed employees with distress: results of a randomised controlled trial. 2010.
    1. Vlasveld MC, van der Feltz-Cornelis CM, Ader HJ, Anema JR, Hoedeman R, van Mechelen W, et al. Collaborative care for sick-listed workers with major depressive disorder: a randomised controlled trial from the Netherlands Depression Initiative aimed at return to work and depressive symptoms. Occup Environ Med. 2013;70:223–30. doi: 10.1136/oemed-2012-100793.
    1. Lagerveld SE, Blonk RWB, Brenninkmeijer V, Wijngaards-de Meij L, Schaufeli WB. Work-focused treatment of common mental disorders and return to work: a comparative outcome study. J Occup Health Psychol. 2012;17:220–34. doi: 10.1037/a0027049.
    1. van Oostrom SH, Anema JR, Terluin B, de Vet HCW, Knol DL, van Mechelen W. Cost-effectiveness of a workplace intervention for sick-listed employees with common mental disorders: design of a randomized controlled trial. BMC Public Health. 2008;8:12. doi: 10.1186/1471-2458-8-12.
    1. van der Feltz-Cornelis CM, Hoedeman R, de Jong FJ, Meeuwissen JA, Drewes HW, van der Laan NC, et al. Faster return to work after psychiatric consultation for sicklisted employees with common mental disorders compared to care as usual. A randomized clinical trial. Neuropsychiatr Dis Treat. 2010;6:375–85. doi: 10.2147/NDT.S11832.
    1. Layard R, Clark D, Knapp M, Mayraz G. Cost-benefit analysis of psychological therapy. Natl Inst Econ Rev. 2007;202:90–8. doi: 10.1177/0027950107086171.
    1. Dupont WD, Plummer WD. Power and sample size calculations. A review and computer program. Control Clin Trials. 1990;11:116–28. doi: 10.1016/0197-2456(90)90005-M.
    1. Bonell C, Fletcher A, Morton M, Lorenc T, Moore L. Realist randomised controlled trials: a new approach to evaluating complex public health interventions. Soc Sci Med. 2012;75:2299–306. doi: 10.1016/j.socscimed.2012.08.032.
    1. Aust B, Nielsen MBD, Grundtvig G, Buchardt HL, Ferm L, Andersen I, et al. Implementation of the Danish return-to-work program: process evaluation of a trial in 21 Danish municipalities. Scand J Work Environ Health. 2015;41:529–41. doi: 10.5271/sjweh.3528.
    1. Valentijn PP, Boesveld IC, van der Klauw DM, Ruwaard D, Struijs JN, Molema JJW, et al. Towards a taxonomy for integrated care: a mixed-methods study. Int J Integr Care. 2015;15:e003. doi: 10.5334/ijic.1513.
    1. Cohen S, Williamson G. Perceived stress in a probability sample of the United States. Soc Psychol Health. 1988;13:31–67.
    1. Brazier J, Roberts J, Tsuchiya A, Busschbach J. A comparison of the EQ-5D and SF-6D across seven patient groups. Health Econ. 2004;13:873–84. doi: 10.1002/hec.866.
    1. Koopman C, Pelletier KR, Murray JF, Sharda CE, Berger ML, Turpin RS, et al. Stanford presenteeism scale: health status and employee productivity. J Occup Environ Med. 2002;44:14–20. doi: 10.1097/00043764-200201000-00004.
    1. Søgaard HJ, Bech P. The effect on length of sickness absence by recognition of undetected psychiatric disorder in long-term sickness absence. A randomized controlled trial. Scand J Public Health. 2009;37:864–71. doi: 10.1177/1403494809347551.
    1. König H-H, Born A, Heider D, Matschinger H, Heinrich S, Riedel-Heller SG, et al. Cost-effectiveness of a primary care model for anxiety disorders. Br J Psychiatry. 2009;195:308–17. doi: 10.1192/bjp.bp.108.058032.
    1. Proudfoot J, Ryden C, Everitt B, Shapiro DA, Goldberg D, Mann A, et al. Clinical efficacy of computerised cognitive-behavioural therapy for anxiety and depression in primary care: randomised controlled trial. Br J Psychiatry. 2004;185:46–54. doi: 10.1192/bjp.185.1.46.
    1. Proudfoot J, Goldberg D, Mann A, Everitt B, Marks I, Gray JA. Computerized, interactive, multimedia cognitive-behavioural program for anxiety and depression in general practice. Psychol Med. 2003;33:217–27. doi: 10.1017/S0033291702007225.
    1. Buszewicz M, Griffin M, McMahon EM, Beecham J, King M. Evaluation of a system of structured, pro-active care for chronic depression in primary care: a randomised controlled trial. BMC Psychiatry. 2010;10:61. doi: 10.1186/1471-244X-10-61.
    1. Mann A, Blizard R, Murray J, Smith J, Botega N, Macdonald E, et al. An evaluation of practice nurses working with general practitioners to treat people with depression. Br J Gen Pract. 1998;48:875–9.
    1. Muntingh ADT, van der Feltz-Cornelis CM, van Marwijk HWJ, Spinhoven P, Assendelft WJJ, de Waal MWM, et al. Collaborative stepped care for anxiety disorders in primary care: aims and design of a randomized controlled trial. BMC Health Serv Res. 2009;9:159. doi: 10.1186/1472-6963-9-159.
    1. Willert MV, Thulstrup AM, Bonde JP. Effects of a stress management intervention on absenteeism and return to work--results from a randomized wait-list controlled trial. Scand J Work Environ Health. 2011;37:186–95. doi: 10.5271/sjweh.3130.
    1. Ejeby K, Savitskij R, Ost L-G, Ekbom A, Brandt L, Ramnerö J, et al. Symptom reduction due to psychosocial interventions is not accompanied by a reduction in sick leave: results from a randomized controlled trial in primary care. Scand J Prim Health Care. 2014;2013:1–6.
    1. Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology. 2009;18:1261–72. doi: 10.1002/pon.1529.
    1. Phillips R, Schneider J, Molosankwe I, Leese M, Foroushani PS, Grime P, et al. Randomized controlled trial of computerized cognitive behavioural therapy for depressive symptoms: effectiveness and costs of a workplace intervention. Psychol Med. 2014;44:741–52. doi: 10.1017/S0033291713001323.

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