Abstract
Objective:Mental health problems often affect functioning to such an extent that they result in sick leave. The worldwide reported prevalence of mental health problems in the working population is 10%–18%. In developed countries, mental health problems are one of the main grounds for receiving disability benefits. In up to 90% of cases the cause is stress-related, and health-care utilisation is mainly restricted to primary care. The aim of this study was to assess the effectiveness of our Minimal Intervention for Stress-related mental disorders with Sick leave (MISS) in primary care, which is intended to reduce sick leave and prevent chronicity of symptoms.Design:Cluster-randomised controlled educational trial.Setting:Primary health-care practices in the Amsterdam area, The Netherlands.Participants:A total of 433 patients (MISS n = 227, usual care [UC] n = 206) with sick leave and self-reported elevated level of distress.Interventions:Forty-six primary care physicians were randomised to either receive training in the MISS or to provide UC. Eligible patients were screened by mail.Outcome Measures:The primary outcome measure was duration of sick leave until lasting full return to work. The secondary outcomes were levels of self-reported distress, depression, anxiety, and somatisation.Results:No superior effect of the MISS was found on duration of sick leave (hazard ratio 1.06, 95% confidence interval 0.87–1.29) nor on severity of self-reported symptoms.Conclusions:We found no evidence that the MISS is more effective than UC in our study sample of distressed patients. Continuing research should focus on the potential beneficial effects of the MISS; we need to investigate which elements of the intervention might be useful and which elements should be adjusted to make the MISS effective.
Highlights
Mental health problems often affect functioning to such an extent that they result in sick leave [1]
The present study is a cluster-randomised controlled effectiveness trial in which primary care physician (PCP) were randomised to an intervention group that was trained to deliver a minimal intervention for stress-related mental disorders, or to a control group that delivered care as usual
A related study completed in occupational health care showed a difference of 15% in full return to work after a period of three months [24], which we considered to be a relevant difference for our trial
Summary
Mental health problems often affect functioning to such an extent that they result in sick leave [1]. People who take sick leave from work as a result of mental health problems very often report that the cause is stress-related. Over the course of the trial, 433 patients with elevated levels of distress and sick leave were included in the study, 227 of whom were treated by practitioners receiving the training program and 206 of whom received usual care. These patients were followed up for 12 months and the primary outcome studied in the trial was the length of sick leave taken until full return to work. Secondary outcome measures included patients’ reports of distress, depression, and other symptoms as recorded using specific questionnaires
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