Self-reported occupational functioning in persons with relapsing-remitting multiple sclerosis: Does personality matter?

BACKGROUND

Multiple sclerosis (MS) poses a major threat to sustainable employability. Identifying conditions and factors that promote work participation is of great importance. Our objective was to explore the contribution of personality traits in explaining occupational functioning in MS.

METHODS

241 participants with relapsing-remitting MS (78% female, median age: 42.0 years, median EDSS: 2.0) and 60 healthy controls (70% female, median age: 45.0 years) underwent neuropsychological and neurological examinations and completed questionnaires. Multivariate logistic and linear regression analyses were conducted to examine relations between personality traits and self-reported occupational functioning, while accounting for known correlates.

RESULTS

Personality traits were not associated with self-reported occupational functioning when correcting for known correlates. A higher impact of fatigue (B = -0.05, p = .005 and B = -0.04, p = .009) and depression (B = -0.22, p = .008 and B = -0.21, p = .01) were associated with no paid job (R² = 0.13) and considering to reduce work hours (R² = 0.12). A higher impact of fatigue (B = -0.05, p = .008, β = 0.46, p = .001 and β = -0.36, p = .001) was associated with absenteeism from work (R² = 0.15), more presenteeism (R² = 0.35) and lower work ability (R² = 0.25). A higher impact of fatigue (β = 0.46, p = .001) and anxiety (β = 0.25, p = .001) were associated with more work difficulties (R² = 0.54).

CONCLUSION

Personality traits did not explain additional variance in self-reported occupational functioning in persons with relapsing-remitting MS with mild disability. The impact of fatigue was the main and most consistent correlate of occupational functioning, often combined with depression or anxiety. Total explained variance of the models was limited, emphasizing the need to additionally examine other (contextual) factors when considering occupational challenges in MS.

The relation between hearing loss and sustainable employability of teachers

Background

Teachers need to hear well. Hearing loss (HL) hinders their daily work. HL is associated with burn-out, depression, sick leave and disability. New retirement policies in The Netherlands encourage people to work longer. Consequently, age-related HL will be an increasing occupational health problem, especially in communicative work such as teaching. Aim of the present study was to examine the relationship between HL and sustainable employability of teachers.

Methods

We invited teachers to participate in an internet survey. Sustainable employability was measured with the reliable and valid Capability Set for Work Questionnaire. Secondary outcome measures were work ability, self-rated health and sick leave. To determine HL among teachers, we used an online speech-in-noise screening test, supplemented with 4 questions about hearing. Ordinal logistic regression analyses were conducted to examine the associations of HL with sustainable employability, work ability, self-rated health and sick leave, adjusted for age, gender, level of education, current hours at work, work content (teaching or a mix of teaching and other tasks) and working as gymnastics teacher. Odds ratios (ORs) and 95% confidence intervals (CI) were estimated.

Results

Of the participating N = 801 teachers, N = 521 had normal hearing and N = 280 had hearing loss. HL was associated with a lower capability set (OR 0.56, CI 0.42-0.73), lower work ability (OR 0.34, CI 0.26-0.46), poorer self-rated health (OR 0.41, CI 0.30-0.55) and a non-significant trend towards more sick leave (OR 1.34, CI 0.98-1.85) as compared to normal hearing.

Conclusions

Hearing loss in teachers was negatively associated with sustainable employability. This underlines the importance of assessing the hearing status of teachers, because of age-related HL especially in those aged 50+. Teachers with HL should be advised on supportive measures, e.g. hearing aids, improved acoustics in the workplace and tasks with less oral communication.

Key messages

Measuring the hearing status, e.g. in periodical health examinations, is highly advisable for sustained employability of teachers. Teachers with hearing loss should be counselled on possible interventions to support them in their work.

One-year trajectories of mental health and work outcomes post return to work in patients with common mental disorders

BACKGROUND

We investigated one-year trajectories of symptom recovery, work functioning and the return to work percentage (RTW%) among patients with common mental disorders (CMDs).

METHODS

Data were used from a cluster-randomised controlled trial evaluating a problem-solving intervention for CMD patients (N = 158) who had returned to work. Information on anxiety and depressive symptoms, work functioning and RTW% was collected at baseline and 3, 6 and 12 months follow-up. Latent class growth analyses were used to identify trajectories for the four outcomes and investigate how these trajectories clustered in higher order latent classes. Additionally, we investigated the relation between patient characteristics and class membership.

RESULTS

We identified four trajectories for all four outcomes and derived three higher order latent classes: slow recovery (42% [66/158]) (high anxiety and depressive symptoms, moderate to low work functioning and fast RTW); fast recovery (25% [40/158]) (low anxiety and depressive symptoms, high work functioning and fast RTW); and gradual recovery (33% [52/158] (decreasing anxiety and depressive symptoms, increasing or low work functioning and fast RTW). Participants with a higher work engagement and readiness to stay at work were more likely to belong to the fast recovery class.

LIMITATIONS

Due to the relatively small sample size, some trajectories consisted of few participants. Symptom severity was self-reported.

CONCLUSIONS

Many CMD patients experience high levels of mental health symptoms and work functioning problems during the year post RTW. Creating realistic recovery expectations (for both patients and their environments) could be important for successful and sustainable recovery and work participation.

The capability set for work - correlates of sustainable employability in workers with multiple sclerosis

Background

The aim of this study was to examine whether work capabilities differ between workers with Multiple Sclerosis (MS) and workers from the general population. The second aim was to investigate whether the capability set was related to work and health outcomes.

Methods

A total of 163 workers with MS from the MS@Work study and 163 workers from the general population were matched for gender, age, educational level and working hours. All participants completed online questionnaires on demographics, health and work functioning. The Capability Set for Work Questionnaire was used to explore whether a set of seven work values is considered valuable (A), is enabled in the work context (B), and can be achieved by the individual (C). When all three criteria are met a work value can be considered part of the individual’s ‘capability set’.

Results

Group differences and relationships with work and health outcomes were examined. Despite lower physical work functioning (U = 4250, p = 0.001), lower work ability (U = 10591, p = 0.006) and worse self-reported health (U = 9091, p ≤ 0.001) workers with MS had a larger capability set (U = 9649, p ≤ 0.001) than the general population. In workers with MS, a larger capability set was associated with better flexible work functioning (r = 0.30), work ability (r = 0.25), self-rated health (r = 0.25); and with less absenteeism (r = − 0.26), presenteeism (r = − 0.31), cognitive/neuropsychiatric impairment (r = − 0.35), depression (r = − 0.43), anxiety (r = − 0.31) and fatigue (r = − 0.34).

Conclusions

Workers with MS have a larger capability set than workers from the general population. In workers with MS a larger capability set was associated with better work and health outcomes.

Trial registration

This observational study is registered under NL43098.008.12: ‘Voorspellers van arbeidsparticipatie bij mensen met relapsing-remitting Multiple Sclerose’. The study is registered at the Dutch CCMO register (https://www.toetsingonline.nl). This study is approved by the METC Brabant, 12 February 2014. First participants are enrolled 1^st of March 2014.

High prevalence of early onset mental disorders among long-term disability claimants

PURPOSE

To provide information on prevalence, comorbidity, age-of-onset and severity of mental disorders among persons claiming disability after long-term sickness absence.

METHOD

Cross-sectional analysis of a cohort of Dutch disability claimants (n = 346). Composite International Diagnostic Interview (CIDI) 3.0 was used to generate DSM-IV classifications of mental disorder, age-of-onset and severity; registry data were used on demographics and ICD-10 classifications of somatic disorder.

RESULTS

The mean age of respondents was 49.8 (range 22-64). The most prevalent broad categories of mental disorders were mood and anxiety disorder with a 12-month prevalence of 28.6% and 32.9%, respectively. Mood and most anxiety disorders had ages of onset in adolescence and early adulthood. The phobias start at school age. Of all respondents, 33.7% had ≥1 12-month mental disorder. Co-occurrence of substance use disorders, phobias and depression/anxiety disorders is frequent. Urogenital and gastrointestinal diseases, and cancer coincide with 12-month mental disorder in 66.7%, 53.9% and 51.7% of cases, respectively. More than two out of three specific mental disorders are serious in terms of disability and days out of working role.

CONCLUSIONS

Disability claimants constitute a vulnerable population with a high prevalence of serious mental disorder, substantial comorbidity and ages-of-onset in early working careers. More research is needed to help prevent long-term sickness absence and disability of claimants with mental health problems.

IMPLICATIONS FOR REHABILITATION

This study shows common mental disorders, such as mood and anxiety disorders, to be highly prevalent among persons claiming disability benefit after long-term sickness absence, to have early onsets and to often co-occur with somatic disorders. Professionals in primary and occupational health care should assess need for treatment of workers at risk, while at the same time being careful not to medicalize normal life problems. Insurance physicians assessing disability benefit claims should identify factors that caused claimants to call in sick and start interventions to promote return to work.

Predictors of functional improvement and future work status after the disability benefit claim: a prospective cohort study

OBJECTIVE

In most industrialized countries, disability benefit rates have increased substantially in the past decade. Few beneficiaries return into employment once disability benefit is awarded. The present study aims to investigate which factors predict functional improvement and future work status among persons claiming disability benefit after having been on long-term sickness leave.

METHODS

Prospective cohort study with 1 year follow-up among disability claimants (n = 375; response rate: 24.3 %) conducted in the Netherlands (October 2008-April 2011). Logistic regression was used to analyze associations between predictors [demographics; outcomes of the 12-item General Health Questionnaire (GHQ-12); 10-item Kessler Psychological Distress scale; Alcohol Use Disorders Identification Test; Trimbos/iMTA questionnaire for Costs associated with Psychiatric Illness; Utrecht Coping List; Social Support Questionnaire for Transactions and Satisfaction; certified International Classification of Diseases 10th edition (ICD-10) diagnosis; loss of earning capacity (LEC)] and outcomes [functional improvement on the World Health Organization Disability Schedule 2.0 (WHODAS 2.0) exceeding the standard error of measurement; work status at follow-up].

RESULTS

Functional improvement on total WHODAS was reported by 84 (31.9 % of 263 claimants included in analysis). Of those not having work at baseline (n = 338), 34 (9.1 %) respondents had paid work 1 year later. Predictors of functional improvement: GHQ-12 sum score >20 [odds ratios (OR) 2.9; 95 % confidence intervals (CI) 1.54-5.34]; of future work status: work status at baseline (OR 16.8; 95 % CI 6.55-43.14), LEC < 80 % (OR 4.6; 95 % CI 1.87-11.42), contact with a medical specialist (OR 0.4; 95 % CI 0.19-0.87).

CONCLUSIONS

Only a limited number of factors were found to significantly predict functional improvement and return to paid work after the disability benefit claim, having paid work at baseline being by far the most important factor.

Predicting improvement of functioning in disability claimants

PURPOSE

In the Netherlands, disability claimants are assessed after 2 years of sick leave, but their functioning may still improve. An accurate prognosis of functioning is difficult. Self predictions may be more accurate than those of professionals. The aim of this study, is to assess and compare the accuracy of predictions by disability claimants and insurance physicians (IPs) working at the Social Security Institute. It is further studied whether the accuracy differs between subgroups of claimants with mental or somatic health conditions.

METHODS

We used data from the prospective cohort study cohort study. Following the assessment of the disability claim (n = 375) and after 1 year follow up (T1, n = 276) data on functioning were obtained from respondents by self-report questionnaire World Health Organization Disability Schedule 2.0. Both claimants and IPs were asked to predict improvement of functioning. Accuracy of their predictions were assessed by sensitivity, specificity, and area under the receiver operating curves (AUC). Mixed logistic regression was conducted to explore differences in accuracy between claimants with mental and somatic conditions.

RESULTS

One-third (32 %) of disability claimants improved beyond the standard error of measurement. Disability claimants' and IPs were able to predict this improvement of functioning, but to a limited extent, with an AUC of 0.61 for IPs and 0.62 for disability claimants. We found no statistically significant differences in the accuracy of the predictions in claimants with mental or somatic health conditions.

CONCLUSIONS

Improvements of functioning were not uncommon. However, both IPs and disability claimants were unable to predict improvement with high levels of accuracy in both mental and somatic health conditions.

Development and validation of the Diagnostic Interview Adjustment Disorder (DIAD)

Adjustment disorders (ADs) are under-researched due to the absence of a reliable and valid diagnostic tool. This paper describes the development and content/construct validation of a fully structured interview for the diagnosis of AD, the Diagnostic Interview Adjustment Disorder (DIAD). We developed the DIAD by partly adjusting and operationalizing DSM-IV criteria. Eleven experts were consulted on the content of the DIAD. In addition, the DIAD was administered by trained lay interviewers to a representative sample of disability claimants (n = 323). To assess construct validity of the DIAD, we explored the associations between the AD classification by the DIAD and summary scores of the Kessler Psychological Distress 10-item Scale (K10) and the World Health Organization Disability Assessment Schedule (WHODAS) by linear regression. Expert agreement on content of the DIAD was moderate to good. The prevalence of AD using the DIAD with revised criteria for the diagnosis AD was 7.4%. The associations of AD by the DIAD with average sum scores on the K10 and the WHODAS supported construct validity of the DIAD. The results provide a first indication that the DIAD is a valid instrument to diagnose AD. Further studies on reliability and on other aspects of validity are needed.

Leadership effectiveness: a supervisor's approach to manage return to work

PURPOSE

To investigate adaptive leadership in relation to personnel sickness absence (SA). In situational leadership, supervisors are effective if they adapt their leadership style appropriately to a given situation.

METHODS

A managerial reorganization in a Dutch hospital with reassignment of supervisors provided the opportunity to compare SA in the same wards while under the leadership of different supervisors. Leadership effectiveness was measured with the Leader Effectiveness and Adaptability Description (LEAD). Personnel SA was retrieved from employer's records and cumulated at the individual level, distinguishing between short-term (1-7 day) and long-term (>7 days) SA. Cumulated SA days and mean SA lengths before and after managerial reorganization were compared at the individual level by using non-parametric paired statistical analyses. Employer's costs to compensate sick-listed employees' salaries before and after reorganization were cumulated and compared at ward level by using non-parametric statistics.

RESULTS

6 wards (N = 403) retained the same supervisor, 6 wards (N = 504) were assigned more effective supervisors, and 4 wards (N = 184) got less effective supervisors than the ones before reorganization. Cumulated short-term SA days and lengths did not change with leadership effectiveness. Employees who got more effective supervisors had fewer long-term SA days and shorter long-term SA lengths than before reorganization. More effective supervisors saved an average of 21,368 Euros per ward, particularly due to less long-term SA.

CONCLUSIONS

Long-term SA was shorter after employees got more effective supervisors. Adaptive supervisors can facilitate return to work and save SA costs by providing the right type of support to sick-listed employees.

Characteristics of zero-absenteeism in hospital care

BACKGROUND

Literature on sickness presenteeism is emerging, but still little is known about employees who are never absent from work due to injuries or illness. Insight into the determinants and characteristics of such zero-absentees may provide clues for preventing sickness absence.

AIMS

To investigate the characteristics of zero-absentees, defined as employees without sickness absence over a period of 5 years.

METHODS

A mixed-method qualitative study comprising semi-structured interviews and focus groups for which Azjen and Fishbein's theory of planned behaviour was used as a framework. Zero-absentees working in hospital care were invited for semi-structured interviews until saturation was reached. The results of semi-structured interviews were validated in two focus groups.

RESULTS

Of 1053 hospital employees, 47 were zero-absentees of whom 31 (66%) agreed to participate in the study. After 16 semi-structured interviews, no new insights or information were gathered from the interviews. The remaining 15 employees were invited to two (n = 8 and n = 7) focus groups. Personal attitudes and self-efficacy were more important in zero-absenteeism than social pressures of managers, colleagues or patients. Zero-absentees were found to be intrinsically motivated to try attending work when ill.

CONCLUSIONS

In the present study population of hospital employees, we found indications that zero-absenteeism and sickness presenteeism might be different types of work attendance. Managers should realize that zero-absentees are driven by intrinsic motivation rather than social pressures to attend work.

Sickness absence due to mental health disorders--a societal perspective

BACKGROUND

Sickness absence (SA) is affected by societal factors. Increasing socioeconomic stress may cause or worsen mental health disorders, which are among the most frequent causes of SA. Employees may also be more cautious about being absent, for example in times of poor economy.

AIMS

To monitor the incidence of SA due to mental health disorders in the Netherlands from 2001 to 2010.

METHODS

Descriptive observational study of long-term (> 3 weeks) SA available from an occupational health service register. The incidence of both total and mental health long-term SA in each year was calculated and evaluated alongside the changes in SA compensation policies, gross national product and national unemployment statistics. The incidence of mental health SA was stratified based on the economic (agricultural, industrial, private, public) sector.

RESULTS

The incidence of both total and mental health SA decreased gradually since 2004, and fell during the economic recession in 2009 in all economic sectors, particularly the agricultural and industrial sectors. The incidence of mental health SA increased with preliminary economic recovery in 2010 in the private and public sectors, but not in the agricultural and industrial sectors.

CONCLUSIONS

Long-term SA due to mental health disorders has decreased since 2004, but further studies across countries are required to confirm and explain this trend.

Return to work after cancer diagnosed in 2002, 2005 and 2008

INTRODUCTION

Improvements in diagnosis and treatment of cancer have increased cancer survival. This study investigated the trends in return to work (RTW) after cancer.

METHODS

All employees absent from work due to cancer diagnosed in 2002 (N = 1209), 2005 (N = 1522), and 2008 (N = 1556) were selected from an occupational health service register. Partial RTW was defined as resuming work with 50% of earnings and full RTW as resuming work with 100% of earnings. The percentages of partial and full RTW were determined 2 years after reporting sick and compared with percentages of partial and full RTW after cardiovascular disorders. The time to partial and full RTW after cancer in 2005 and 2008 was compared with the time to RTW in 2002.

RESULTS

Partial RTW decreased from 85% 2 years after cancer diagnosis in 2002 to 80% in 2005 and 69% in 2008. Full RTW decreased from 80% 2 years after cancer diagnosis in 2002 to 74% in 2005 and 60% in 2008. RTW after cardiovascular disorders showed similar changes. The time to partial RTW in 2008 was longer than in 2002 after gastrointestinal cancer and lung cancer. The time to full RTW in 2008 was longer than in 2002 after breast cancer, gastrointestinal cancer and lung cancer.

CONCLUSIONS

In the past decade, the percentages of employees who resumed work after cancer have decreased in The Netherlands, while the time to RTW increased. Possible explanations include changes in disability policy, economic decline, and resulting decreases in work latitude and workplace accommodations.

Prognostic factors of long term disability due to mental disorders: a systematic review

INTRODUCTION In the past few decades, mental health problems have increasingly contributed to sickness absence and long-term disability. However, little is known about prognostic factors of return to work (RTW) and disability of persons already on sick leave due to mental health problems. Understanding these factors may help to develop effective prevention and intervention strategies to shorten the duration of disability and facilitate RTW. METHOD We reviewed systematically current scientific evidence about prognostic factors for mental health related long term disability, RTW and symptom recovery. Searching PubMed, PsycINFO, Embase, Cinahl and Business Source Premier, we selected articles with a publication date from January 1990 to March 2009, describing longitudinal cohort studies with a follow-up period of at least 1 year. Participants were persons on sick leave or receiving disability benefit at baseline. We assessed the methodological quality of included studies using an established criteria list. Consistent findings in at least two high quality studies were defined as strong evidence and positive findings in one high quality study were defined as limited evidence. RESULTS Out of 796 studies, we included seven articles, all of high methodological quality describing a range of prognostic factors, according to the ICF-model categorized as health-related, personal and external factors. We found strong evidence that older age (>50 years) is associated with continuing disability and longer time to RTW. There is limited evidence for the association of other personal factors (gender, education, history of previous sickness absence, negative recovery expectation, socio-economic status), health related (stress-related and shoulder/back pain, depression/anxiety disorder) and external i.e., job-related factors (unemployment, quality and continuity of occupational care, supervisor behavior) with disability and RTW. We found limited evidence for the association of personal/external factors (education, sole breadwinner, partial/full RTW, changing work tasks) with symptom recovery. CONCLUSION This systematic review identifies a number of prognostic factors, some more or less consistent with findings in related literature (mental health factors, age, history of previous sickness absence, negative recovery expectation, socio-economic status, unemployment, quality and continuity of occupational care), while other prognostic factors (gender, level of education, sole breadwinner, supervisor support) conflict with existing evidence. There is still great need for research on modifiable prognostic factors of continuing disability and RTW among benefit claimants with mental health problems. Recommendations are made as to directions and methodological quality of further research, i.e., prognostic cohort studies.

Trends in return to work of breast cancer survivors

Most women interrupt their work activities during the treatment of cancer. This study investigated return to work (RTW) after treatment of breast cancer in the period from January 2002 to December 2008. ArboNed Occupational Health Service records the sickness absence and RTW data of more than one million workers of whom approximately 40% are women. Incident cases of sickness absence due to breast cancer (ICD-10 code C50) were selected from the ArboNed register. Proportions of partial RTW, with 50% of the earnings before sickness absence, and full RTW were determined 1 year after diagnosis. Trends in partial RTW and full RTW were examined by Chi-square trend analysis. The time to partial RTW and full RTW was analysed by Cox regression and stratified by age (<40 years, 40-50 years and >50 years). The proportion of partial RTW was stable around 70% from 2002 to 2008. The proportion of full RTW decreased from 52% in 2002 to 43% in 2008 and showed a linear decline in women of all ages. The time to partial RTW and full RTW in the years 2003-2008 did not change significantly compared with 2002. In the Netherlands, the proportion of employed women who fully resumed working after breast cancer within 1 year of diagnosis has decreased since 2002. These results warrant more epidemiological research to examine the trends in RTW of breast cancer survivors across countries.

Factors associated with work participation and work functioning in depressed workers: a systematic review

BACKGROUND

Depression is associated with negative work outcomes such as reduced work participation (WP) (e.g., sick leave duration, work status) and work functioning (WF) (e.g., loss of productivity, work limitations). For the development of evidence-based interventions to improve these work outcomes, factors predicting WP and WF have to be identified.

METHODS

This paper presents a systematic literature review of studies identifying factors associated with WP and WF of currently depressed workers.

RESULTS

A total of 30 studies were found that addressed factors associated with WP (N = 19) or WF (N = 11). For both outcomes, studies reported most often on the relationship with disorder-related factors, whereas personal factors and work-related factors were less frequently addressed. For WP, the following relationships were supported: strong evidence was found for the association between a long duration of the depressive episode and work disability. Moderate evidence was found for the associations between more severe types of depressive disorder, presence of co-morbid mental or physical disorders, older age, a history of previous sick leave, and work disability. For WF, severe depressive symptoms were associated with work limitations, and clinical improvement was related to work productivity (moderate evidence). Due to the cross-sectional nature of about half of the studies, only few true prospective associations could be identified.

CONCLUSION

Our study identifies gaps in knowledge regarding factors predictive of WP and WF in depressed workers and can be used for the design of future research and evidence-based interventions. We recommend undertaking more longitudinal studies to identify modifiable factors predictive of WP and WF, especially work-related and personal factors.

Trends in the incidence of sickness absence due to common mental disorders between 2001 and 2007 in the Netherlands

BACKGROUND

Mental disorders are an important public health problem because of their prevalence and the probability of long-term work disability. The incidence of sickness absence with mental disorders has increased between 1985 and 2000, but little is known about trends in recent years. This study investigated the incidence of sickness absence due to common mental disorders in the Netherlands from 2001 to 2007.

METHODS

Observational study in about 1 million employees, working in various economic sectors, representative for the Dutch workforce. Sickness absence episodes were medically certified by an occupational physician utmost in the fifth week of absence. The 12-month incidence of medically certified sickness absence was calculated for each year by dividing incident episodes by the number of employees. Sick days due to common mental disorders were computed as percentage of the total number of medically certified sick days.

RESULTS

The 12-month incidence of sickness absence due to common mental disorders was 2.2% in 2001, increased to 2.7% in 2004 and decreased thereafter to 2.0% in 2007. The percentage of sick days due to common mental disorders was highest in the education sector (39%) followed by financial services (31%) and health care (30%).

CONCLUSIONS

In the Netherlands, the incidence of sickness absence with common mental disorders was highest in 2004 and has decreased since then probably because of changes in sick leave compensation, economic market position and company policies.

Reducing long term sickness absence by an activating intervention in adjustment disorders: a cluster randomised controlled design

AIMS

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.

CONCLUSION

The experimental intervention for adjustment disorders was successful in shortening sick leave duration, mainly by decreasing long term absenteeism.