Decision aid on disclosure of mental health status to an employer: feasibility and outcomes of a randomised controlled trial.
BACKGROUND
Many mental health service users delay or avoid disclosing their condition to employers because of experience, or anticipation, of discrimination. However, non-disclosure precludes the ability to request 'reasonable adjustments'. There have been no intervention studies to support decision-making about disclosure to an employer.


OBJECTIVE
To determine whether the decision aid has an effect that is sustained beyond its immediate impact; to determine whether a large-scale trial is feasible; and to optimise the designs of a larger trial and of the decision aid.


METHODS
In this exploratory randomised controlled trial (RCT) in London, participants were randomly assigned to use of a decision aid plus usual care or usual care alone. Follow-up was at 3 months. Primary outcomes were: (a) stage of decision-making; (b) decisional conflict; and (c) employment-related outcomes (trial registration number: NCT01379014).


RESULTS
We recruited 80 participants and interventions were completed for 36 out of 40 in the intervention group; in total 71 participants were followed up. Intention-to-treat analysis showed that reduction in decisional conflict was significantly greater in the intervention group than among controls (mean improvement -22.7 (s.d. = 15.2) v. -11.2 (s.d. = 18.1), P = 0.005). More of the intervention group than controls were in full-time employment at follow-up (P = 0.03).


CONCLUSIONS
The observed reduction in decisional conflict regarding disclosure has a number of potential benefits which next need to be tested in a definitive trial.
Claire Henderson, PhD, MRCPsych, Elaine Brohan, PhD, Sarah Clement, PhD, Cpsychol, Paul Williams, MSc, Francesca Lassman, MSc, Oliver Schauman, MSc, Lisa Dockery, MSc, Simone Farrelly, PhD, Joanna Murray, BA, Health Service and Population Research Department, Institute of Psychiatry, King's College London; Caroline Murphy, DipHE Nursing (Adult), MSc Clinical Trials, KCTU, Department of Biostatistics, Institute of Psychiatry, King's College London; Mike Slade, PhD, PsychD, Graham Thornicroft, PhD, FRCPsych, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK.
Claire
C
Henderson
Elaine
E
Brohan
Sarah
S
Clement
Paul
P
Williams
Francesca
F
Lassman
Oliver
O
Schauman
Lisa
L
Dockery
Simone
S
Farrelly
Joanna
J
Murray
Caroline
C
Murphy
Mike
M
Slade
Graham
G
Thornicroft
D000328:Adult; D003220:Conflict, Psychological; D003657:Decision Making; D003661:Decision Support Techniques; D004651:Employment / Q000331:legislation & jurisprudence* / Q000523:psychology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D028642:Persons with Psychiatric Disorders / Q000523:psychology*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D012107:Research Design; D016037:Single-Blind Method; D063508:Social Discrimination / Q000523:psychology; D014342:Truth Disclosure