The objective of this study is to assess the effects of treatment by the occupational physician of employees with mental health problems according to the guideline, compared with usual care.
ID
Source
Brief title
Condition
- Adjustment disorders (incl subtypes)
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
Return to work (RTW) was chosen as the primary outcome in this study with a
follow-up time of one year after inclusion. Treatment satisfaction by employee,
employer and the treating occupational physician is another primary outcome
Secondary outcome
Cost-effectiveness of the intervention is a secondary outcome and was evaluated
from the employers and the health care insurance company*s perspective
(expenditures for the employer and insurance company, respectively), as they
are responsible for covering the costs of sick leave and treatment.
Background summary
Mental health problems often lead to prolonged sick leave. In the Netherlands,
mental health problems are responsible for approximately one third of all
employees disabled for over a year. Many share the view that better treatment
and early intervention could prevent long lasting disability for work.
Early 2000, the Dutch Association of Occupational Physicians (NVAB) has
published an authorized guideline concerning the management of employees with
mental health problems by occupational physicians.
Study objective
The objective of this study is to assess the effects of treatment by the
occupational physician of employees with mental health problems according to
the guideline, compared with usual care.
Study design
In a randomized controlled trial (RCT), subjects in the intervention group were
treated according to the guideline. The control group received usual care, with
minimal involvement of the occupational physician and frequent referral to a
psychologist.
Intervention
The intervention consisted of treatment by OPs according to the guideline of
employees on sick leave due to mental health problems. The guideline promotes a
more active role of the OP as case and care manager facilitating return to work
of the employee. The guideline is based on an activating approach, time
contingent process evaluation and cognitive behavioral principles. The latter
mainly concern stress inoculation training and graded activity and aim to
enhance the problem-solving capacity of patients in relation to their work
environment.
The guideline focuses on four aspects of the management of mental health
problems. First, an early and activating guidance by the OP is promoted, in
which return to work is part of the recovery process, even if the mental health
problems are not related to work. Second, a simplified classification of mental
health problems is introduced, with only four categories: 1) adjustment
disorder (distress, nervous breakdown, burnout), 2) depression, 3) anxiety, and
4) other psychiatric disorders. Third, the OP acts as case manager, who is
stimulated to be a care manager by counselling employees with adjustment
disorders and work-related problems. Fourth, the OP performs a time contingent
process evaluation and intervenes when recovery stagnates.
OPs participating in the study received training in the guideline before the
study started.
Study burden and risks
not applicable
Van der Boechorststraat 7
1081 BT Amsterdam
Nederland
Van der Boechorststraat 7
1081 BT Amsterdam
Nederland
Listed location countries
Age
Inclusion criteria
As the guideline focuses on all kinds of mental health problems, we aimed to include employees with a broad range of mental health problems consulting their OP. Employees were included if they met the following inclusion criteria:
· Mental health problems according to the diagnosis of the OP
· Sick leave at the moment of inclusion
· Sick leave period did not start before 2002.
Exclusion criteria
Exclusion criteria were the same as stated in the OP-guideline:
· Mental health symptoms that were caused by somatic illness
· Disagreement between OP and employee about the diagnosis
· Lack of confidence in the relation between OP and employee
The application of the exclusion criteria was dependent on the OPs expert judgement. To prevent selection bias, employees were not included of whom the period of sick leave started before 2002.
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| ISRCTN | ISRCTN34887348 |
| CCMO | NL18371.029.07 |