Sick leave and return to work for patients with anxiety and depression: a longitudinal study of trajectories before, during and after work-focused treatment

Return to Work Trajectories of Swedish Employees on Sick-Leave Due to Common Mental Disorders

OBJECTIVES

Recent research has emphasized that return to work (RTW) is a dynamic, gradual and often uneven process with a great degree of individual variation. This study aimed to identify RTW trajectories of Swedish employees on sick-leave due to common mental disorders (CMDs). The second aim was to explore which demographic, employment, health-related and work environment characteristics predicted RTW trajectory membership.

METHODS

Data comes from two 2-armed cluster-randomized controlled trials (RCT) with a 12-month follow-up. A participative problem-solving intervention aimed to reduce sick-leave was compared to care as usual (CAU) involving any kind of work-directed interventions. Participants on sick-leave due to CMDs at baseline (N = 197) formed the study sample. Latent growth mixture modeling and logistic regression were the main analytical approaches.

RESULTS

Five distinct RTW trajectories of Swedish employees were identified: Early RTW (N = 65), Delayed RTW (N = 50), Late RTW (N = 39), Struggling RTW (N = 21) and No RTW (N = 22). RTW trajectories differed consistently with regard to previous sick-leave duration and social support at work. More unique predictors of RTW trajectories included gender, rewards at work, work performance impairment due to health problems, home-to-work interference and stress-related exhaustion disorder.

CONCLUSION

The study may have important clinical implications for identifying patients belonging to a particular RTW trajectory. Knowledge on the modifiable work environment factors that differentiated between the RTW trajectories could be useful for designing effective workplace interventions, tailored to particular needs of employees with CMDs. However, in a first step, the results need to be replicated.

Responsiveness to change in health status of the EQ-5D in patients treated for depression and anxiety

BACKGROUND

The EQ-5D is a commonly used generic measure of health but evidence on its responsiveness to change in mental health is limited. This study aimed to explore the responsiveness of the five-level version of the instrument, the EQ-5D-5 L, in patients receiving treatment for depression and anxiety.

METHODS

Patient data (N = 416) were collected at baseline and at end of treatment in an observational study in a Norwegian outpatient clinic. Patients were adults of working age (18-69 years) and received protocol-based metacognitive or cognitive therapy for depression or anxiety according to diagnosis. Responsiveness in the EQ-5D was compared to change in the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI). Effect sizes (Cohen's d), Standardised response mean (SRM), and Pearson's correlation were calculated. Patients were classified as "Recovered", "Improved", or "Unchanged" during treatment using the BDI-II and the BAI. ROC analyses determined whether the EQ-5D could correctly classify patient outcomes.

RESULTS

Effect sizes were large for the BAI, the BDI-II, the EQ-5D value and the EQ VAS, ranging from d = 1.07 to d = 1.84. SRM were also large (0.93-1.67). Pearson's correlation showed strong agreement between change scores of the EQ-5D value and the BDI-II (r_s -0.54) and moderate between the EQ-5D value and the BAI (r_s -0.43). The EQ-5D consistently identified "Recovered" patients versus "Improved" or "Unchanged" in the ROC analyses with AUROC ranging from 0.72 to 0.84.

CONCLUSION

The EQ-5D showed good agreement with self-reported symptom change in depression and anxiety, and correctly identified recovered patients. These findings indicate that the EQ-5D may be appropriately responsive to change in patients with depression and anxiety disorders, although replication in other clinical samples is needed.

Predictors of Return to Work for People with Anxiety or Depression Participating in a Randomized Trial Investigating the Effect of a Supported Employment Intervention

Purpose Common mental disorders have a severe impact on society and individuals; rates of unemployment and disability pensions are high. Knowing which factors facilitate or hinder people's return to work is important when designing effective vocational rehabilitation interventions. Methods We conducted secondary analyses on data from 289 participants with depression or anxiety included in the Individual Placement and Support modified for people with mood and anxiety disorders (IPS-MA) trial. Associations of baseline characteristics and employment or education after 24 months were tested in univariate logistic regression analyses, variables with a p-value below 0.1 were included in multivariate analyses. Results In the univariate analyses, self-reported level of functioning (p = 0.032), higher age (p = 0.070), and higher level of readiness to change (p = 0.001) were associated with the outcome and included in the multivariate analysis. Only age (p = 0.030) and readiness to change (p = 0.003) remained significantly associated with return to work or education after 24 months in the multivariate analysis. Conclusion Higher age and lower readiness to change were associated with a lower chance of having returned to work or education. Factors modifying the effect of higher age should be identified, just as vocational rehabilitation should focus on improving factors related to people's readiness to change.

Work after mental-health-related absence: a qualitative study of perceived change after a combination of metacognitive therapy and work-focused interventions

BACKGROUND

Sick leave caused by common mental health disorders (CMD) is becoming more prevalent. For most people, work is essential for good mental and physical health. It is necessary to provide treatments that facilitate return to work (RTW) and a reduction of symptoms. A qualitative study can contribute to an understanding of what makes an intervention successful. The aim of this study was to investigate how individuals who are on sick leave because of CMD perceive and handle their symptoms and their work, after completing metacognitive therapy and work-focused interventions.

METHODS

Semi-structured interviews were conducted with 23 participants after they had completed therapy. Thematic analysis was used to analyse the data.

RESULTS

Through both therapy and the process of RTW, the participants had gained increased awareness and understanding of their mental health problems and the relationship between those problems and work. Together with the sense that they were in charge of their own process of RTW, this helped to improve their self-confidence. An important part of the process was the change to new strategies and the rejection of older maladaptive ones, in relation to both mental health and work. Being open about their mental illness in the workplace could lead to support but also to the opposite, and therefore not an option for everyone. After treatment, most had returned to work and gained a more positive outlook on the future, but some had less confidence in their ability to deal with future symptoms and workplace issues.

CONCLUSIONS

Achieving improved self-confidence and adopting new strategies, which enabled them to change how they related to their mental problems and how they addressed their problems at work, seemed to have increased their self-efficacy. Active involvement in therapy and at work was also important, both for the process and as a way of increasing self-efficacy. This gave them renewed belief in themselves and in their ability to handle their work at present and in the future. Despite this being a manualized treatment, the participants' experience was that it was adapted to each individual, something they regarded as important.

Changes in depression domains as predictors of return to work in common mental disorders

BACKGROUND

Depression highly impairs function and reduces quality of life. Therefore, both symptomatic and functional recovery are important treatment goals. Depression consists of several cognitive, somatic, and affective symptom factors that differently affect function. However, it is unclear whether changes in these domains predict return to work (RTW) after treatment.

METHODS

Data were collected during treatment from patients on full or partial sick leave reporting depression symptoms (N = 300) at an out-patient clinic. Information on work status was assessed pre- and post-treatment and at 6 months follow-up. Multiple logistic regression was used to investigate if residualized changes in symptom factors predicted full RTW, controlling for gender, education level, and age.

RESULTS

Changes (as symptom improvement) in the cognitive, somatic, and affective factor scores each significantly predicted full RTW post-treatment and at follow-up for patients on full and partial sick leave, even after controlling for gender, education level, and age. The change in the somatic factor explained the largest proportion of variance for full work post-treatment in patients on full sick-leave, while change in the cognitive factor explained most unique variance for patients on graded sick leave.

LIMITATIONS

The sample consisted of a majority of women with a relatively high level of education. This study should be replicated in more heterogeneous samples.

CONCLUSION

Changes in depression symptom domains are significant predictors for RTW work post-treatment. The change in the somatic factor explained the largest proportion of variance in patients on full sick leave and thus may particularly influence RTW after treatment.