Towards a shortened sick leave duration of employees sick-listed due to common mental disorders

Sickness absence due to common mental disorders (CMD) such as anxiety,
depression, burnout and distress is a problem in many Western countries. In the
Netherlands, about one third of people receiving disability benefits do so
because of mental health problems, the majority of which are common mental
health problems, including emotional distress. Longer absences are associated
with a reduced probability of eventual return to work, resulting in a weakened
financial position, social isolation and exclusion from the labor market. Apart
from these individual disadvantages, sickness absence forms an economic burden
on society. On average, employees on sick leave because of minor mental
disorders or emotional distress were found to be absent from work for over 100
days before they fully or even partially returned to work. Considering the
scope of the problem, it is surprising that only very few international studies
have been conducted on sick leave due to mental disorders, as opposed to
physical problems.

In 2000, the Netherlands Society of Occupation Medicine (NVAB) published a
practice guideline entitled: The management of workers with common mental
health problems by occupation physicians', and in 2007, this guideline was
revised (see: http://nvab.artsennet.nl/Artikel-3/Psychische-Problemen.htm).
The guideline promotes a more active role of the occupational physician (OP)
facilitating work resumption. The guideline consists of four consecutive steps:
(1) problem orientation and diagnosis; (2) intervention, which includes
enhancing problem solving and using cognitive behavioural techniques,
provinding information, and communication between OP and GP if problems sustain
or worsen; and (3) relaps prevention (4) evaluation (with worker, supervisor,
other involved professionals) and closure.
A previous study found that Dutch OPs have a positive attitude towards the
guideline and intend to apply it in practice, but that actual compliance with
the guideline appeared to be minimal. A retrospective study showed that closer
adherence to this guideline was associated with a shortened sick leave
duration.

The objective of this study is to investigate:
•Why do Dutch occupational physicians currently adhere only minimally to the
guideline, and how can these barriers overcome? (phase 1)
•Does adherence to this guideline lead to a shortened sick leave duration of
the workers? (phase 2)

Multi centre two armed cluster randomized controlled trial with randomization
on the level of the OPs.
First, 66 OPs are included in the study. They are randomised to either the
experimental group (N=32) or the control group (N=34). Prior to the start of
the study, OPs, companies and participating workers all sign an informed
consent. This trial has a longitudinal design, with 4 measurements.
Participants will be asked to complete 4 questionnaires over the course of 1
year, i.e. at baseline (T0), then after 3 (T1), 6 (T2) and 12 (T3) months. Only
if (additional) written permission from the participant has been obtained,
his/her superior at work will be send a brief questionnaire, and guideline
adherence of the OP will be checked in the participant*s medical file.

OPs in the experimental group receive additional training in appropriate
guideline use for 1 year. It is expected that after this training, OPs of the
experimental group will adhere the guideline more closely when treating workers
with CMD. OPs from the control group do not receive any additional training and
will provide care as usual.

Concerning the consultation by the OP no risk are expected. It concerns an
existing evidence based guideline recommended by the NVAB. For participation in
the study, sick listed workers fill out 4 questionnaires over the course of one
year. The questions are about aspects related to the sick-leave situation such
as symptoms, workability, job characteristics, coping, self-efficacy,
remoralisation, and social support. Workers* participation in the study is
entirely voluntary and they can withdraw from the study whenever they want,
without any consequences.