title: Reducing long term sickness absence by an activating intervention in adjustment disorders: a cluster randomised controlled design.
abstract: OBJECTIVE
  To compare an innovative activating intervention with "care as usual" (control group) for the guidance of employees on sickness leave because of an adjustment disorder. It was hypothesised that the intervention would be more effective than care as usual in lowering the intensity of symptoms, increasing psychological resources, and decreasing sickness leave duration.
  
  
  METHODS
  A prospective, cluster randomised controlled trial was carried out with 192 patients on first sickness leave for an adjustment disorder. Symptom intensity, sickness duration, and return to work rates were measured at 3 months and 12 months. Analyses were performed on an intention to treat basis.
  
  
  RESULTS
  At 3 months, significantly more patients in the intervention group had returned to work compared with the control group. At 12 months all patients had returned to work, but sickness leave was shorter in the intervention group than in the control group. The recurrence rate was lower in the intervention group. There were no differences between the two study groups with regard to the decrease of symptoms. At baseline, symptom intensity was higher in the patients than in a normal reference population, but decreased over time in a similar manner in both groups to approximately normal levels.
  
  
  CONCLUSIONS
  The experimental intervention for adjustment disorders was successful in shortening sick leave duration, mainly by decreasing long term absenteeism.
authors.affiliation: Coronel Institute for Occupational and Environmental Health, Academic Medical Center, Netherlands. j.j.vanderklink@amc.uva.nl
authors.forename: J J L
authors.initials: JJ
authors.lastname: van der Klink
authors.forename: R W B
authors.initials: RW
authors.lastname: Blonk
authors.forename: A H
authors.initials: AH
authors.lastname: Schene
authors.forename: F J H
authors.initials: FJ
authors.lastname: van Dijk
mesh_terms: D000041:Absenteeism; D000275:Adjustment Disorders / Q000517:prevention & control* / Q000534:rehabilitation; D000328:Adult; D000704:Analysis of Variance; D016000:Cluster Analysis; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D011340:Problem Solving; D011446:Prospective Studies; D012050:Rehabilitation, Vocational; D055502:Secondary Prevention; D018582:Sick Leave; D016896:Treatment Outcome