Cost-effectiveness of an activating intervention by social workers for patients with minor mental disorders on sick leave: a randomized controlled trial.
BACKGROUND
Sickness absence often occurs in patients with emotional distress or minor mental disorders. In several European countries, these patients are over-represented among those receiving illness benefits, and interventions are needed. The aim of this study was to evaluate the cost-effectiveness of an intervention conducted by social workers, designed to reduce sick leave duration in patients absent from work owing to emotional distress or minor mental disorders.


METHODS
In this Randomized Controlled Trial, patients were recruited by GPs. The intervention group (N = 98) received an activating, structured treatment by social workers, the control group (N = 96) received routine GP care. Sick leave duration, clinical symptoms, and medical consumption (consumption of medical staffs' time as well as consumption of drugs) were measured at baseline and 3, 6, and 18 months later.


RESULTS
Neither for sick leave duration nor for clinical improvement over time were significant differences found between the groups. Also the associated costs were not significantly lower in the intervention group.


CONCLUSIONS
Compared with usual GP care, the activating social work intervention was not superior in reducing sick leave duration, improving clinical symptoms, and decreasing medical consumption. It was also not cost-effective compared with GP routine care in the treatment of minor mental disorders. Therefore, further implementation of the intervention is not justified. Potentially, programmes aimed at reducing sick leave duration in patients with minor mental disorders carried out closer to the workplace (e.g. by occupational physicians) are more successful than programmes in primary care.
Brouwers
Evelien P M
EP
Netherlands Institute for Health Services Research (NIVEL) Utrecht, the Netherlands.
de Bruijne
Martine C
MC
Terluin
Berend
B
Tiemens
Bea G
BG
Verhaak
Peter F M
PF
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000342:Affective Symptoms / Q000191:economics* / Q000453:epidemiology / Q000534:rehabilitation; D003362:Cost-Benefit Analysis; D005194:Family Practice / Q000191:economics / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000191:economics* / Q000453:epidemiology / Q000534:rehabilitation; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010353:Patient Education as Topic / Q000379:methods*; D011340:Problem Solving; D015397:Program Evaluation; D012050:Rehabilitation, Vocational / Q000191:economics / Q000379:methods; D018582:Sick Leave / Q000706:statistics & numerical data*; D012949:Social Work, Psychiatric / Q000191:economics / Q000379:methods*; D013997:Time Factors