Zugang und Nachsorge bei Psychotherapie

Evaluating a multimodal, clinical and work-directed intervention (RTW-PIA) to support sustainable return to work among employees with mental disorders: study protocol of a multicentre, randomised controlled trial

BACKGROUND

Mental disorders (MDs) are one of the leading causes for workforce sickness absence and disability worldwide. The burden, costs and challenges are enormous for the individuals concerned, employers and society at large. Although most MDs are characterised by a high risk of relapse after treatment or by chronic courses, interventions that link medical-psychotherapeutic approaches with work-directed components to facilitate a sustainable return to work (RTW) are rare. This protocol describes the design of a study to evaluate the (cost-)effectiveness and implementation process of a multimodal, clinical and work-directed intervention, called RTW-PIA, aimed at employees with MDs to achieve sustainable RTW in Germany.

METHODS

The study consists of an effectiveness, a health-economic and a process evaluation, designed as a two-armed, multicentre, randomised controlled trial, conducted in German psychiatric outpatient clinics. Sick-listed employees with MDs will receive either the 18-month RTW-PIA treatment in conjunction with care as usual, or care as usual only. RTW-PIA consists of a face-to-face individual RTW support, RTW aftercare group meetings, and web-based aftercare. Assessments will be conducted at baseline and 6, 12, 18 and 24 months after completion of baseline survey. The primary outcome is the employees´ achievement of sustainable RTW, defined as reporting less than six weeks of working days missed out due to sickness absence within 12 months after first RTW. Secondary outcomes include health-related quality of life, mental functioning, RTW self-efficacy, overall job satisfaction, severity of mental illness and work ability. The health-economic evaluation will be conducted from a societal and public health care perspective, as well as from the employer's perspective in a cost-benefit analysis. The design will be supplemented by a qualitative effect evaluation using pre- and post-interviews, and a multimethod process evaluation examining various predefined key process indicators from different stakeholder perspectives.

DISCUSSION

By applying a comprehensive, multimethodological evaluation design, this study captures various facets of RTW-PIA. In case of promising results for sustainable RTW, RTW-PIA may be integrated into standard care within German psychiatric outpatient clinics.

TRIAL REGISTRATION

The study was prospectively registered with the German Clinical Trials Register ( DRKS00026232 , 1 September 2021).

[Technology-Based Psychological Interventions (TBIs) for Bridging Waiting Periods and Aftercare for People with Depressive Disorders: The Current State of Research]

Our goal was to present current research on the effectiveness, acceptance and safety of technology-based psychological interventions (TBIs) for bridging waiting periods (e. g., for outpatient psychotherapy) and aftercare of people with depressive disorders and to derive implications for future research. In this systematic review of 83 studies, the use of TBIs in people with diagnosed depression was analyzed. Among these, only a few studies were identified as those applying TBIs for bridging waiting periods (n=1) and aftercare (n=4). The narrative summary of results suggests the effectiveness of TBIs for aftercare. However, very few data are available on TBIs regarding their acceptance, safety and use for bridging waiting periods. The current evidence base is insufficient for recommending the use of TBIs for bridging waiting periods and for aftercare. Further randomized controlled trials capturing effectiveness, acceptance, safety, and the potential for implementation of TBIs under real-world care conditions are needed.

Internet-based aftercare for patients with personality disorders and trauma-related disorders: A pilot study

Preventing readmission after hospital discharge is a major issue with regard to the continuity of patients' recovery process and the financial burden on the healthcare system, but adequate aftercare services are lacking. Therefore, a pilot study was conducted to examine the feasibility and acceptability of an Internet-based aftercare program for patients with personality disorders (PD) and / or trauma-related disorders as well as to obtain a preliminary estimate of effects on symptomatology and readmission. Patients' satisfaction with the program and symptomatology (KPD-38, BDI-II) were assessed prior to hospital discharge (t1) and after three months of participation (t2). Log data on program utilization (i.e., logins, page hits, and chat use) were automatically assessed via server logs. N = 31 of 45 eligible patients consented to participate. 84% used the intervention at least once. The average duration of participation was 63 days (SD = 4.6). Patients attended on average 7.2 out of 12 group chat sessions (SD = 4.0). Findings indicate very high acceptance of and satisfaction with the intervention. Symptomatology on all outcomes was stable, no deteriorations could be observed. 20% reported readmission within the aftercare period. Efficacy and cost-effectiveness should be tested with a large-scale randomized controlled trial.