Abstract
After a period of decrease, sick leave in Sweden due to psychiatric diagnoses is on the increase. The lack of established rehabilitation programmes for patients with stress-related mental disorders (SRMD) has opened up for the use of garden/nature in a multimodal rehabilitation context (Nature-Based Rehabilitation, NBR). Region Västra Götaland (VGR) started an NBR to offer additional rehabilitation for its employees on long-term sick leave due to SRMD, where initial care had not been sufficient. The aim was to explore whether the mental health and well-being of NBR participants had improved at the end of the NBR and at three follow-ups, and to explore the development of sick leave and health care utilization according to the NBR model (n = 57) and an occupational health service (OHS) model (n = 45). Self-assessment instruments for measuring burnout, depression, anxiety and wellbeing, and data from regional and national registers were used. Results showed decreased scores on burnout, depression and anxiety, and increased well-being scores and significantly reduced health care utilization in the NBR group. A large movement from ordinary sickness benefit to rehabilitation benefit was observed, which was not observed in the OHS group. The two groups were in different rehabilitation phases, which limited comparisons. The results point to beneficial effects of using NBR for this patient group and for enhancing a stalled rehabilitation process.
Highlights
After a peak in 2002, sick leave spells in Sweden began decreasing
The main findings in this study were that participants in Nature-Based Rehabilitation (NBR) showed decreased scores of self-assessed burnout, depression, anxiety, and increased scores of well-being at all follow-ups compared to start of rehabilitation
A large proportion of the participants increased their level of activity by moving from ordinary sickness benefit to rehabilitation benefit, an important step towards return to work
Summary
After a peak in 2002, sick leave spells in Sweden began decreasing. during the period 2009 to 2012 this downward trend was interrupted; the number of new cases of illness with psychiatric diagnoses has turned upwards again, and is forecasted to soon reach the same high numbers as in2005 [1]. The dominating diagnoses in this new wave of sick leaves due to stress-related health problems are adjustment disorder and reaction to severe stress (ICD code F43; about 40%) and depressive episodes (ICD code F32; approximately 30%) [1]. Employees in health and social care, a large sector where 85% of the employees are women, dominate in this regard. In the report from the Swedish Social Insurance Agency [2] from autumn 2013 psychiatric diagnoses forms the largest diagnosis group for both women and men. Sick leaves due to psychiatric disorders are more common among individuals aged 30–49 years [1]. Mental illness and pain are the most common causes of reduced work ability, and work-related health issues caused by mental strain have become more common in the past 15 years [4]
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