Effectiveness of a coordinated and tailored return-to-work intervention for sickness absence beneficiaries with mental health problems.
OBJECTIVE
Sickness absence and exclusion from the labour market due to mental health problems (MHPs) is a growing concern in many countries. Knowledge about effective return-to-work (RTW) intervention models is still limited, but a multidisciplinary, coordinated and tailored approach has shown promising results in the context of musculoskeletal disorders. The purpose of this study was to assess the effectiveness of this approach as implemented among sickness absence beneficiaries with MHPs.


METHODS
In a quasi-randomised, controlled trial, we assessed the intervention's effect in terms of time to RTW and labour market status after 1 year. We used two different analytical strategies to compare time to RTW between participants receiving the intervention (n = 88) and those receiving conventional case management (n = 80): (1) a traditional multivariable regression analysis controlling for measured confounding, and (2) an instrumental variable (IV) analysis controlling for unmeasured confounding.


RESULTS
The two analytical approaches provided similar results in terms of a longer time to RTW among recipients of the intervention (HR = 0.50; 95 % CI 0.34-0.75), although the estimate provided by the IV-analysis was non-significant (HR = 0.70; 95 % CI 0.23-2.12). After 1 year, more recipients of the intervention than of conventional case management were receiving sickness absence benefits (p = 0.031).


CONCLUSIONS
The intervention delayed RTW compared to conventional case management, after accounting for measured confounding. The delayed RTW may be due to either implementation or program failure, or both. It may also reflect the complexity of retaining employees with mental health problems in the workplace.
National Research Centre for the Working Environment, Lersø Parkalle 105, 2100, Copenhagen, Denmark, mti@nrcwe.dk.
Marie H T
MH
Martin
Maj Britt D
MB
Nielsen
Ida E H
IE
Madsen
Signe M A
SM
Petersen
Theis
T
Lange
Reiner
R
Rugulies
D000223:Adaptation, Psychological; D000328:Adult; D004185:Disability Evaluation; D015444:Exercise; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D001523:Mental Disorders / Q000534:rehabilitation*; D008875:Middle Aged; D062707:Return to Work; D018582:Sick Leave; D013997:Time Factors