Prevention of recurrent sickness absence among employees with common mental disorders: design of a cluster-randomised controlled trial with cost-benefit and effectiveness evaluation

Iris Arends,Ute Bültmann,Jac Jl Van Der Klink

doi:10.1186/1471-2458-10-132

Abstract

BackgroundCommon mental disorders, such as depression, anxiety disorder, and adjustment disorder, have emerged as a major public and occupational health problem in many countries. These disorders can have severe consequences such as absenteeism and work disability. Different interventions have been developed to improve the return-to-work of employees with common mental disorders, but still a large proportion of employees experiences health and work problems after their return-to-work. For this reason, the SHARP-at work intervention is developed to prevent a relapse of sickness absence among employees who have returned to work after a period of sickness absence because of common mental disorders. We aim to evaluate the effectiveness, cost-benefit and process of the intervention compared to care as usual.Methods/DesignThe study is designed as a cluster-randomised controlled trial with randomisation at the level of the occupational physician. Employees who have returned to work after a period of sickness absence because of a common mental disorder are included in the study. Employees in the intervention group will receive the SHARP-at work intervention. The intervention focusses on active guidance of employees by occupational physicians during the first weeks of work after sickness absence. Employees in the control group will receive care as usual. Outcomes will be assessed at baseline and at 3, 6, and 12 months follow-up. The primary outcome is cumulative recurrent sickness absence days. Secondary outcome measures are mental health, work functioning, and coping. Adherence to the protocol, communication between stakeholders, and satisfaction with the treatment are the process measures assessed in both study groups. Cost-benefit is calculated from a societal perspective. Finally, prognostic factors for a relapse of sickness absence are investigated.DiscussionThis study goes beyond return-to-work by focussing on the prevention of recurrent sickness absence. The study incorporates not only outcomes on sickness absence and mental health but also on health-related work functioning. The results of this study can contribute to a further development of practice guidelines and the promotion of sustainable work participation.Trial registrationNTR1963

Highlights

Common mental disorders, such as depression, anxiety disorder, and adjustment disorder, have emerged as a major public and occupational health problem in many countries
The primary aim of this study is to evaluate the effectiveness of the Stimulating Healthy participation and Relapse Prevention (SHARP)-at work intervention compared to care as usual (CAU) in preventing a relapse of sickness absence among employees who have returned to work after a period of sickness absence because of a Common mental disorders (CMDs)
Randomisation occurs at the level of the occupational physicians (OPs) because employees can not be randomly assigned to OPs and OPs can not be expected to provide both guidance according to the SHARP-at work intervention and CAU

Summary

Introduction

Common mental disorders, such as depression, anxiety disorder, and adjustment disorder, have emerged as a major public and occupational health problem in many countries. Lerner and Henke show that depression is significantly associated with a reduction of job performance and productivity; it was demonstrated that employees with a significant improvement in depression still have more trouble with performing well compared to their healthy colleagues [6] These findings emphasize the importance of interventions aiming at employees with CMDs who are at work. Research in the Netherlands showed that one out of five employees who have returned to work after a sickness absence period because of a CMD experiences a relapse of sickness absence due to CMDs (Koopmans et al, submitted for publication) For these reasons, we have developed an intervention aiming at the prevention of a relapse of sickness absence among employees who have (partially/ fully) returned to work after a period of sickness absence because of a CMD

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