Abstract
BackgroundDepression 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.MethodsA 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.ResultsForty (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.ConclusionsThe 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 registrationRetrospectively registered at December 18, 2018 at clinicaltrials.gov, identifier: NCT03786328.
Highlights
Depression and anxiety are prevalent mental disorders among the working population with potentially high personal and financial cost
The conditions have potentially high personal and financial costs given their association with long-term and recurrent sickness absence, at-work performance deficit, early retirement, decreased social function, low job satisfaction and impaired quality of life [2, 4,5,6,7,8,9,10,11]
In addition to clinical conditions, many employees are affected by symptoms of depression and anxiety at a subclinical level which may be socially inhibiting for the individual as well as negatively impacting job satisfaction, work productivity and attendance [1, 10, 14]
Summary
Depression and anxiety are prevalent mental disorders among the working population with potentially high personal and financial cost. In addition to clinical conditions, many employees are affected by symptoms of depression and anxiety at a subclinical level which may be socially inhibiting for the individual as well as negatively impacting job satisfaction, work productivity and attendance [1, 10, 14]. Untreated and not early identified, these subclinical cases can lead to actual mental disorder [15, 16] In both the general population and the working population, evidence has demonstrated a high level of unmet need for mental health care and treatment [17,18,19]. The unmet needs are partly explained by diagnostic difficulties and inadequate treatment in general practice, and partly by the fact that many individuals affected do not seek professional help [20, 21]
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