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Rothermund E, Pößnecker T, Antes A, Kilian R, Kessemeier F, von Wietersheim J, Mayer D, Rieger MA, Gündel H, Hölzer M, Balint EM, Mörtl K. Conceptual Framework of a Psychotherapeutic Consultation in the Workplace: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14894. [PMID: 36429612 PMCID: PMC9690206 DOI: 10.3390/ijerph192214894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/28/2022] [Accepted: 11/05/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: A new health care offer called 'psychotherapeutic consultation in the workplace' is an early and effective intervention for employees with common mental disorders. Although cost-effective, it lacks a broader roll-out. This might be attributable to undefined context, mechanisms of change, and a lack of communication; therefore, this study explores how the new model works and where problems occur. (2) Methods: Semi-structured interviews on motivation, expectations and experiences with 20 involved experts. Experts were members of the company health promotion team, service users, and cooperating mental health specialists. Analysis was conducted with ATLAS.ti. (3) Results: The conceptual framework comprises three main topics: (a) structured implementation concept; (b) persons involved, shaping the concept's processes; (c) and meaning and function of the offer within the given context. Concerning (c) we found three potential areas of conflict: (1) intra-corporate conflicts, (2) conflicts between company and employee, (3) and conflicts between the company health promotion and the health care system. Category (c) comprises the offer's core characteristics which were described as low-threshold and preventive. Furthermore, the offer was perceived as convenient in handling, confidential, and having immediate impact on a person's well-being. (4) Conclusions: Here we define structures, address the needs of the involved persons, and communicate foreseeable areas of conflict influences whether the implementation of the intervention succeeds.
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Affiliation(s)
- Eva Rothermund
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
- Leadership Personality Center Ulm (LPCU), Ulm University, Kornhausgasse 9, 89073 Ulm, Germany
| | - Tim Pößnecker
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
- Leadership Personality Center Ulm (LPCU), Ulm University, Kornhausgasse 9, 89073 Ulm, Germany
| | - Andreas Antes
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Reinhold Kilian
- Department of Psychiatry II, Ulm University Medical Center at BKH Günzburg, Lindenallee 2, 89312 Günzburg, Germany
| | - Franziska Kessemeier
- Leadership Personality Center Ulm (LPCU), Ulm University, Kornhausgasse 9, 89073 Ulm, Germany
| | - Jörn von Wietersheim
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Dorothea Mayer
- Health and Safety Sindelfingen, Daimler AG, Bela-Barenyi-Straße, 71059 Sindelfingen, Germany
| | - Monika A. Rieger
- Institute for Occupational and Social Medicine and Health Services Research, University Clinic Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
- Leadership Personality Center Ulm (LPCU), Ulm University, Kornhausgasse 9, 89073 Ulm, Germany
| | - Michael Hölzer
- Leadership Personality Center Ulm (LPCU), Ulm University, Kornhausgasse 9, 89073 Ulm, Germany
- Sonnenbergklinik, ZfP Südwürttemberg, Christian-Belser-Straße 79, 70597 Stuttgart, Germany
| | - Elisabeth M. Balint
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
- Leadership Personality Center Ulm (LPCU), Ulm University, Kornhausgasse 9, 89073 Ulm, Germany
| | - Kathrin Mörtl
- Faculty of Psychotherapy Science, Sigmund Freud University, Freudplatz 1, 1020 Vienna, Austria
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Menear M, Girard A, Dugas M, Gervais M, Gilbert M, Gagnon MP. Personalized care planning and shared decision making in collaborative care programs for depression and anxiety disorders: A systematic review. PLoS One 2022; 17:e0268649. [PMID: 35687610 PMCID: PMC9187074 DOI: 10.1371/journal.pone.0268649] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/04/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Collaborative care is an evidence-based approach to improving outcomes for common mental disorders in primary care. Efforts are underway to broadly implement the collaborative care model, yet the extent to which this model promotes person-centered mental health care has been little studied. The aim of this study was to describe practices related to two patient and family engagement strategies-personalized care planning and shared decision making-within collaborative care programs for depression and anxiety disorders in primary care. METHODS We conducted an update of a 2012 Cochrane review, which involved searches in Cochrane CCDAN and CINAHL databases, complemented by additional database, trial registry, and cluster searches. We included programs evaluated in a clinical trials targeting adults or youth diagnosed with depressive or anxiety disorders, as well as sibling reports related to these trials. Pairs of reviewers working independently selected the studies and data extraction for engagement strategies was guided by a codebook. We used narrative synthesis to report on findings. RESULTS In total, 150 collaborative care programs were analyzed. The synthesis showed that personalized care planning or shared decision making were practiced in fewer than half of programs. Practices related to personalized care planning, and to a lesser extent shared decision making, involved multiple members of the collaborative care team, with care managers playing a pivotal role in supporting patient and family engagement. Opportunities for quality improvement were identified, including fostering greater patient involvement in collaborative goal setting and integrating training and decision aids to promote shared decision making. CONCLUSION This review suggests that personalized care planning and shared decision making could be more fully integrated within collaborative care programs for depression and anxiety disorders. Their absence in some programs is a missed opportunity to spread person-centered mental health practices in primary care.
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Affiliation(s)
- Matthew Menear
- VITAM Research Centre for Sustainable Health, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada
- * E-mail:
| | - Ariane Girard
- VITAM Research Centre for Sustainable Health, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada
| | - Michèle Dugas
- VITAM Research Centre for Sustainable Health, Quebec, Quebec, Canada
| | - Michel Gervais
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
| | - Michel Gilbert
- Centre National d’Excellence en Santé Mentale, Quebec, Quebec, Canada
| | - Marie-Pierre Gagnon
- VITAM Research Centre for Sustainable Health, Quebec, Quebec, Canada
- Faculty of Nursing, Université Laval, Quebec, Quebec, Canada
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The effectiveness of enhanced evidence-based care for depressive disorders: a meta-analysis of randomized controlled trials. Transl Psychiatry 2021; 11:531. [PMID: 34657142 PMCID: PMC8520525 DOI: 10.1038/s41398-021-01638-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 08/13/2021] [Accepted: 09/08/2021] [Indexed: 11/26/2022] Open
Abstract
Several care models have been developed to improve treatment for depression, all of which provide "enhanced" evidence-based care (EEC). The essential component of these approaches is Measurement-Based Care (MBC). Specifically, Collaborative Care (CC), and Algorithm-guided Treatment (AGT), and Integrated Care (IC) all use varying forms of rigorous MBC assessment, care management, and/or treatment algorithms as key instruments to optimize treatment delivery and outcomes for depression. This meta-analysis systematically examined the effectiveness of EEC versus usual care for depressive disorders based on cluster-randomized studies or randomized controlled trials (RCTs). PubMed, the Cochrane Library, and PsycInfo, EMBASE, up to January 6th, 2020 were searched for this meta-analysis. The electronic search was supplemented by a manual search. Standardized mean difference (SMD), risk ratio (RR), and their 95% confidence intervals (CIs) were calculated and analyzed. A total of 29 studies with 15,255 participants were analyzed. EEC showed better effectiveness with the pooled RR for response of 1.30 (95%CI: 1.13-1.50, I2 = 81.9%, P < 0.001, 18 studies), remission of 1.35 (95%CI: 1.11-1.64, I2 = 85.5%, P < 0.001, 18 studies) and symptom reduction with a pooled SMD of -0.42 (95%CI: -0.61-(-0.23), I2 = 94.3%, P < 0.001, 19 studies). All-cause discontinuations were similar between EEC and usual care with the pooled RR of 1.08 (95%CI: 0.94-1.23, I2 = 68.0%, P = 0.303, 27 studies). This meta-analysis supported EEC as an evidence-based framework to improve the treatment outcome of depressive disorders.Review registration: PROSPERO: CRD42020163668.
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Björk Brämberg E, Arapovic-Johansson B, Bültmann U, Svedberg P, Bergström G. Prevention of sick leave at the workplace: design of a cluster-randomized controlled trial of a problem-solving intervention among employees with common mental disorders. BMC Public Health 2021; 21:1756. [PMID: 34565357 PMCID: PMC8474950 DOI: 10.1186/s12889-021-11786-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background Common mental disorders are highly prevalent in the working population, affecting about 1 in 5 persons in the Organisation for Economic Co-operation and Development countries. About 30% of those affected have a first period of sick leave. Despite several attempts to reduce the risk of sick leave among employees with common mental disorders, there is a lack of knowledge about effective, preventive interventions which aim to reduce such risks. This protocol describes the design of a study to evaluate the effectiveness of a problem-solving intervention delivered by first-line managers to employees with common mental disorders on the prevention of sick leave during the 12-month follow-up. Methods/design The study applies a two-armed cluster-randomized trial design of a problem-solving intervention conducted in private-sector companies. First-line managers are randomized into intervention- or control groups by computer-generated random numbers, allocation ratio 1:1. Employees are eligible if at risk for future sick leave due to common mental disorders. These are identified by self-reported psychological health measured by the General Health Questionnaire 12-item, cut-off ≥3, or a positive answer to risk of sick leave. The intervention is based on problem-solving principles. It involves the training of the first-line managers who then deliver the intervention to employees identified at risk of sick leave. First-line managers in the control group receives a lecture. Primary outcome is number of registered days of sick leave due to common mental disorders during the 12-month follow-up. Secondary outcomes are general health, psychological symptoms, work performance, work ability and psychosocial work environment. A process evaluation will examine the intervention’s reach, fidelity, dose delivered, dose received, satisfaction and context. Research assistants managing the screening procedure, outcome assessors and employees are blinded to randomization and allocation. Discussion The study includes analyses of the intervention’s effectiveness and an alongside process evaluation. Methodological strengths and limitations, for example the risk of selection bias, attrition and risk of contamination are discussed. Trial registration Clinicaltrials.gov NCT04975750 Date of registration: 08/16/2021.
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Affiliation(s)
- E Björk Brämberg
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Stockholm, Sweden.
| | - B Arapovic-Johansson
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Stockholm, Sweden
| | - U Bültmann
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community & Occupational Medicine, Groningen, The Netherlands.,Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - P Svedberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - G Bergström
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Stockholm, Sweden.,Department of Occupational Health Sciences and Psychology, University of Gävle, Gävle, Sweden
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Balint EM, Gantner M, Gündel H, Herrmann K, Pößnecker T, Rothermund E, von Wietersheim J. [Providing Rapid Help for Mental Strain at the Workplace: Psychosomatic Consultation in the Workplace]. Psychother Psychosom Med Psychol 2021; 71:437-445. [PMID: 34282599 DOI: 10.1055/a-1479-3045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Psychosomatic consultation in the workplace (PSIW) is an offer for employees who are under mental and psychosomatic strain. Core elements are early diagnosis and short-term psychotherapy with the aim of improving the care for mentally stressed employees. This article provides a characterization of patients and presents initial data on the effects of short-term psychotherapy. MATERIALS AND METHODS From 05/2016 to 12/2019, basic data were collected from all employees seeking help. Socio-demographic data, previous treatments, work ability, depression (PHQ-9), anxiety (GAD-7), somatic symptoms (PHQ-15), assessment of psychological state and attitudes towards treatment options were collected by self-report before and (if applicable) after a short-term intervention. RESULTS A total of 672 employees from 20 companies (49% male) were mostly referred to PSIW by the company physician. Adjustment disorders and depressive disorders each accounted for almost one-third of diagnoses. A quarter of the employees presenting at PSIW were on sick leave at the time of referral. The most frequent recommendations were short-term intervention at PSIW, followed by outpatient psychotherapy. A total of 343 (51%) employees completed the questionnaires, of which 187 (55%) of them received short-term psychotherapy. The symptoms improved significantly across all scales. Satisfaction with PSIW was very high. CONCLUSIONS PSIW is an innovative care concept in the work context, which is well accepted and effective in various sectors. Close cooperation with company stakeholders such as occupational health physicians is important for a successful outcome.
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Affiliation(s)
- Elisabeth Maria Balint
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Deutschland
| | - Melanie Gantner
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Deutschland
| | - Harald Gündel
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Deutschland
| | - Kristin Herrmann
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Deutschland
| | - Tim Pößnecker
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Deutschland
| | - Eva Rothermund
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Deutschland
| | - Jörn von Wietersheim
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Deutschland
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Grigoroglou C, van der Feltz-Cornelis C, Hodkinson A, Coventry PA, Zghebi SS, Kontopantelis E, Bower P, Lovell K, Gilbody S, Waheed W, Dickens C, Archer J, Blakemore A, Adler DA, Aragones E, Björkelund C, Bruce ML, Buszewicz M, Carney RM, Cole MG, Davidson KW, Gensichen J, Grote NK, Russo J, Huijbregts K, Huffman JC, Menchetti M, Patel V, Richards DA, Rollman B, Smit A, Zijlstra-Vlasveld MC, Wells KB, Zimmermann T, Unutzer J, Panagioti M. Effectiveness of collaborative care in reducing suicidal ideation: An individual participant data meta-analysis. Gen Hosp Psychiatry 2021; 71:27-35. [PMID: 33915444 DOI: 10.1016/j.genhosppsych.2021.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/15/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
UNLABELLED To assess whether CC is more effective at reducing suicidal ideation in people with depression compared with usual care, and whether study and patient factors moderate treatment effects. METHOD We searched Medline, Embase, PubMed, PsycINFO, CINAHL, CENTRAL from inception to March 2020 for Randomised Controlled Trials (RCTs) that compared the effectiveness of CC with usual care in depressed adults, and reported changes in suicidal ideation at 4 to 6 months post-randomisation. Mixed-effects models accounted for clustering of participants within trials and heterogeneity across trials. This study is registered with PROSPERO, CRD42020201747. RESULTS We extracted data from 28 RCTs (11,165 patients) of 83 eligible studies. We observed a small significant clinical improvement of CC on suicidal ideation, compared with usual care (SMD, -0.11 [95%CI, -0.15 to -0.08]; I2, 0·47% [95%CI 0.04% to 4.90%]). CC interventions with a recognised psychological treatment were associated with small reductions in suicidal ideation (SMD, -0.15 [95%CI -0.19 to -0.11]). CC was more effective for reducing suicidal ideation among patients aged over 65 years (SMD, - 0.18 [95%CI -0.25 to -0.11]). CONCLUSION Primary care based CC with an embedded psychological intervention is the most effective CC framework for reducing suicidal ideation and older patients may benefit the most.
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Affiliation(s)
- Christos Grigoroglou
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England.
| | | | - Alexander Hodkinson
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | - Peter A Coventry
- Department of Health Sciences, University of York, York, England
| | - Salwa S Zghebi
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | - Evangelos Kontopantelis
- Faculty of Biology, Medicine and Health, Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, England
| | - Peter Bower
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, England; Greater Manchester Mental Health NHS Foundation Trust, Manchester, England
| | - Simon Gilbody
- Department of Health Sciences, Hull York Medical School, HYMS, University of York, York, England
| | - Waquas Waheed
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | | | - Janine Archer
- School of Health and Society, School of Health and Society, University of Salford, England
| | - Amy Blakemore
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, England
| | - David A Adler
- Departments of Psychiatry and Medicine, Tufts Medical Center and Tufts University School of Medicine, England
| | - Enric Aragones
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
| | - Cecilia Björkelund
- Primary Health Care School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Martha L Bruce
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Marta Buszewicz
- Institute of Epidemiology and Health, Faculty of Population and Health Sciences, University College London, London, England
| | - Robert M Carney
- Department of Psychiatry, Washington University in St. Louis (WUSTL), St. Louis, Missouri, USA
| | - Martin G Cole
- Department of Psychiatry, St. Mary's Hospital Center, McGill University, Montreal, Quebec, Canada
| | - Karina W Davidson
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, LMU Klinikum, Ludwig-Maximilians, University Munich Pettenkoferstr. 10, 80336 Munich, Germany
| | - Nancy K Grote
- School of Social Work, University of Washington, Seattle, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Klaas Huijbregts
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Jeff C Huffman
- Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Vikram Patel
- The Pershing Square Professor of Global Health, Harvard Medical School, Boston, MA, USA
| | - David A Richards
- Institute of Health Research, University of Exeter College of Medicine and Health, Exeter, England; Western University of Norway, Bergen, Norway
| | - Bruce Rollman
- Center for Behavioral Health, Media and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Annet Smit
- HAN University of Applied Sciences, Nijmegen, Netherlands
| | | | - Kenneth B Wells
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA; Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
| | - Thomas Zimmermann
- Department of General Practice / Primary Care, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jurgen Unutzer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Maria Panagioti
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
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Parsons V, Juszczyk D, Gilworth G, Ntani G, McCrone P, Hatch S, Shannon R, Henderson M, Coggon D, Molokhia M, Smedley J, Griffiths A, Walker-Bone K, Madan I. A case management occupational health model to facilitate earlier return to work of NHS staff with common mental health disorders: a feasibility study. Health Technol Assess 2021; 25:1-94. [PMID: 33641712 PMCID: PMC7957455 DOI: 10.3310/hta25120] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The NHS is the biggest employer in the UK. Depression and anxiety are common reasons for sickness absence among staff. Evidence suggests that an intervention based on a case management model using a biopsychosocial approach could be cost-effective and lead to earlier return to work for staff with common mental health disorders. OBJECTIVE The objective was to assess the feasibility and acceptability of conducting a trial of the clinical effectiveness and cost-effectiveness of an early occupational health referral and case management intervention to facilitate the return to work of NHS staff on sick leave with any common mental health disorder (e.g. depression or anxiety). DESIGN A multicentre mixed-methods feasibility study with embedded process evaluation and economic analyses. The study comprised an updated systematic review, survey of care as usual, and development of an intervention in consultation with key stakeholders. Although this was not a randomised controlled trial, the study design comprised two arms where participants received either the intervention or care as usual. PARTICIPANTS Participants were NHS staff on sick leave for 7 or more consecutive days but less than 90 consecutive days, with a common mental health disorder. INTERVENTION The intervention involved early referral to occupational health combined with standardised work-focused case management. CONTROL/COMPARATOR Participants in the control arm received care as usual. PRIMARY OUTCOME The primary outcome was the feasibility and acceptability of the intervention, study processes (including methods of recruiting participants) and data collection tools to measure return to work, episodes of sickness absence, workability (a worker's functional ability to perform their job), occupational functioning, symptomatology and cost-effectiveness proposed for use in a main trial. RESULTS Forty articles and two guidelines were included in an updated systematic review. A total of 49 of the 126 (39%) occupational health providers who were approached participated in a national survey of care as usual. Selected multidisciplinary stakeholders contributed to the development of the work-focused case management intervention (including a training workshop). Six NHS trusts (occupational health departments) agreed to take part in the study, although one trust withdrew prior to participant recruitment, citing staff shortages. At mixed intervention sites, participants were sequentially allocated to each arm, where possible. Approximately 1938 (3.9%) NHS staff from the participating sites were on sick leave with a common mental health disorder during the study period. Forty-two sick-listed NHS staff were screened for eligibility on receipt of occupational health management referrals. Twenty-four (57%) participants were consented: 11 (46%) received the case management intervention and 13 (54%) received care as usual. Follow-up data were collected from 11 out of 24 (46%) participants at 3 months and 10 out of 24 (42%) participants at 6 months. The case management intervention and case manager training were found to be acceptable and inexpensive to deliver. Possible contamination issues are likely in a future trial if participants are individually randomised at mixed intervention sites. HARMS No adverse events were reported. LIMITATIONS The method of identification and recruitment of eligible sick-listed staff was ineffective in practice because uptake of referral to occupational health was low, but a new targeted method has been devised. CONCLUSION All study questions were addressed. Difficulties raising organisational awareness of the study coupled with a lack of change in occupational health referral practices by line managers affected the identification and recruitment of participants. Strategies to overcome these barriers in a main trial were identified. The case management intervention was fit for purpose and acceptable to deliver in the NHS. TRIAL REGISTRATION Current Controlled Trials ISRCTN14621901. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 12. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Vaughan Parsons
- Occupational Health Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Dorota Juszczyk
- Occupational Health Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Gill Gilworth
- Occupational Health Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Georgia Ntani
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- National Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Paul McCrone
- King's Health Economics, King's College London, London, UK
| | - Stephani Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Robert Shannon
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Max Henderson
- Liaison Psychiatry, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - David Coggon
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Mariam Molokhia
- Population Health Sciences, King's College London, London, UK
| | - Julia Smedley
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Amanda Griffiths
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Karen Walker-Bone
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- National Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Ira Madan
- Occupational Health Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Faculty of Life Sciences & Medicine, King's College London, London, UK
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8
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Axén I, Björk Brämberg E, Vaez M, Lundin A, Bergström G. Interventions for common mental disorders in the occupational health service: a systematic review with a narrative synthesis. Int Arch Occup Environ Health 2020; 93:823-838. [PMID: 32246230 PMCID: PMC7452923 DOI: 10.1007/s00420-020-01535-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 03/12/2020] [Indexed: 12/14/2022]
Abstract
Introduction Common mental disorders (CMD) are leading causes of decreased workability in Sweden and worldwide. Effective interventions to prevent or treat such disorders are important for public health. Objective To synthesize the research literature regarding occupational health service (OHS) interventions targeting prevention or reduction of CMD among employees. The effect on workability (sickness absence, return-to-work and self-reported workability) and on CMD symptoms was evaluated in a narrative analysis. Data sources The literature search was performed in four electronic databases in two searches, in 2014 and in 2017. Eligibility criteria (using PICO) Population: studies investigating employees at risk or diagnosed with CMD, as well as preventive workplace intervention targeting mental health. Intervention: studies where the recruitment or the intervention was delivered by the OHS or OHS personnel were included. Control: individuals or groups who did not receive the target intervention. Outcome: all types of outcomes concerning sickness absence and psychological health were included. Study quality was assessed using a Swedish AMSTAR-based checklist, and results from studies with low or medium risk of bias were narratively synthesized based on effect or absence thereof. Results Thirty-three studies were included and assessed for risk of bias. Twenty-one studies had low or medium risk of bias. In 18 studies, rehabilitation interventions were evaluated, 11 studies concerned interventions targeting employees at risk for developing CMD and four studies investigated preventive interventions. Work-focused cognitive behavioral therapy and problem-solving skill interventions decreased time to first return-to-work among employees on sick leave for CMD in comparison with treatment-as-usual. However, effect on return to full-time work was not consistent, and these interventions did not consistently improve CMD symptoms. Selective interventions targeting employees at risk of CMD and preventive interventions for employees were heterogeneous, so replication of these studies is necessary to evaluate effect. Limitations Other workplace interventions outside the OHS may have been missed by our search. There was considerable heterogeneity in the included studies, and most studies were investigating measures targeting the individual worker. Interventions at the workplace/organizational level were less common. Conclusions and implication of key findings Return-to-work and improvement of CMD symptoms are poorly correlated and should be addressed simultaneously in future interventions. Further, interventions for CMD administered through the occupational health service require further study. Rehabilitative and preventive strategies should be evaluated with scientifically robust methods, to examine the effectiveness of such interventions.
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Affiliation(s)
- Iben Axén
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - Elisabeth Björk Brämberg
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
- Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, 405 30, Gothenburg, Sweden
| | - Marjan Vaez
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Andreas Lundin
- Department for Public Health Sciences, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Gunnar Bergström
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
- Department of Occupational Health Sciences and Psychology, University of Gävle Centre for Musculoskeletal Research, Kungsbäcksvägen 47, 801 76, Gävle, Sweden
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9
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Moriarty AS, Coventry PA, Hudson JL, Cook N, Fenton OJ, Bower P, Lovell K, Archer J, Clarke R, Richards DA, Dickens C, Gask L, Waheed W, Huijbregts KM, van der Feltz-Cornelis C, Ali S, Gilbody S, McMillan D. The role of relapse prevention for depression in collaborative care: A systematic review. J Affect Disord 2020; 265:618-644. [PMID: 31791677 DOI: 10.1016/j.jad.2019.11.105] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 10/01/2019] [Accepted: 11/21/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Relapse (the re-emergence of depression symptoms before full recovery) is common in depression and relapse prevention strategies are not well researched in primary care settings. Collaborative care is effective for treating acute phase depression but little is known about the use of relapse prevention strategies in collaborative care. We undertook a systematic review to identify and characterise relapse prevention strategies in the context of collaborative care. METHODS We searched for Randomised Controlled Trials (RCTs) of collaborative care for depression. In addition to published material, we obtained provider and patient manuals from authors to provide more detail on intervention content. We reported the extent to which collaborative care interventions addressed four relapse prevention components. RESULTS 93 RCTs were identified. 31 included a formal relapse prevention plan; 42 had proactive monitoring and follow-up after the acute phase; 39 reported strategies for optimising sustained medication adherence; and 20 of the trials reported psychological or psycho-educational treatments persisting beyond the acute phase or focussing on long-term health/relapse prevention. 30 (32.3%) did not report relapse prevention approaches. LIMITATIONS We did not receive trial materials for approximately half of the trials, which limited our ability to identify relevant features of intervention content. CONCLUSION Relapse is a significant risk amongst people treated for depression and interventions are needed that specifically address and minimise this risk. Given the advantages of collaborative care as a delivery system for depression care, there is scope for more consistency and increased effort to implement and evaluate relapse prevention strategies.
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Affiliation(s)
- Andrew S Moriarty
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
| | - Peter A Coventry
- Department of Health Sciences and Centre for Reviews and Dissemination, University of York, Heslington, York, YO10 5DD, UK.
| | - Joanna L Hudson
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Natalie Cook
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
| | - Oliver J Fenton
- Tees, Esk and Wear Valleys NHS Foundation Trust, South and West Community Mental Health Team, Acomb Garth, 2 Oak Rise, York, YO24 4LJ, UK.
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Karina Lovell
- Division of Nursing, Midwifery & Social Work, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Janine Archer
- School of Health and Society, University of Salford, Mary Seacole Building, Broad St, Frederick Road Campus, Salford, M6 6PU, UK.
| | - Rose Clarke
- Sheffield IAPT, St George's Community Health Centre, Winter Street, Sheffield, South Yorkshire, S3 7ND, UK.
| | - David A Richards
- Institute of Health Research, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Chris Dickens
- Institute of Health Research, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Linda Gask
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Waquas Waheed
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Klaas M Huijbregts
- GGNet, Mental Health, RGC SKB Winterswijk, Beatrixpark 1, 7101 BN Winterswijk, The Netherlands.
| | | | - Shehzad Ali
- Epidemiology and Biostatistics Department, Schulich School of Medicine & Dentistry, Western University, Kresge Building, Room K201, London, Ontario, N6A 5C1, Canada; Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.
| | - Simon Gilbody
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
| | - Dean McMillan
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
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10
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Who Should Play a Key Role in Preventing Common Mental Disorders that Affect Employees in the Workplace? Results of a Survey with Occupational Health Physicians, Primary Care Physicians, Psychotherapists, and Human Resource Managers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16081383. [PMID: 30999612 PMCID: PMC6517970 DOI: 10.3390/ijerph16081383] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/02/2019] [Accepted: 04/15/2019] [Indexed: 11/17/2022]
Abstract
The rising burden of common mental disorders (CMDs) in employees requires strategies for prevention. No systematic data exist about how those involved perceive their roles, responsibilities, and interactions with other professional groups. Therefore, we performed a multi-professional standardized survey with health professionals in Germany. A self-administered questionnaire was completed by 133 occupational health physicians (OHPs), 136 primary care physicians (PCPs), 186 psychotherapists (PTs), and 172 human resource managers (HRMs). Inter alia, they were asked which health professionals working in the company health service and in the outpatient care or in the sector of statutory insurance agents should play a key role in the primary, secondary, and tertiary prevention of CMDs in employees. The McNemar test was used in order to compare the attributed roles among the professionals involved. With regard to CMDs, all the professional groups involved in this study declared OHPs as the most relevant pillar in the field of prevention. In primary prevention, HRMs regarded themselves, OHPs, and health insurance agents as equally relevant in terms of prevention. PTs indicated an important role for employee representatives in this field. In secondary prevention, PCPs were regarded as important as OHPs. HRMs indicated themselves as equally important as OHPs and PCPs. In tertiary prevention, only OHPs identified themselves as main protagonists. The other groups marked a variety of several professions. There is a common acceptance from the parties involved that might help the first steps be taken toward overcoming barriers, e.g., by developing a common framework for quality-assured intersectional cooperation in the field of CMD prevention in employees.
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11
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Cullen KL, Irvin E, Collie A, Clay F, Gensby U, Jennings PA, Hogg-Johnson S, Kristman V, Laberge M, McKenzie D, Newnam S, Palagyi A, Ruseckaite R, Sheppard DM, Shourie S, Steenstra I, Van Eerd D, Amick BC. Effectiveness of Workplace Interventions in Return-to-Work for Musculoskeletal, Pain-Related and Mental Health Conditions: An Update of the Evidence and Messages for Practitioners. JOURNAL OF OCCUPATIONAL REHABILITATION 2018; 28:1-15. [PMID: 28224415 PMCID: PMC5820404 DOI: 10.1007/s10926-016-9690-x] [Citation(s) in RCA: 227] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Purpose The objective of this systematic review was to synthesize evidence on the effectiveness of workplace-based return-to-work (RTW) interventions and work disability management (DM) interventions that assist workers with musculoskeletal (MSK) and pain-related conditions and mental health (MH) conditions with RTW. Methods We followed a systematic review process developed by the Institute for Work & Health and an adapted best evidence synthesis that ranked evidence as strong, moderate, limited, or insufficient. Results Seven electronic databases were searched from January 1990 until April 2015, yielding 8898 non-duplicate references. Evidence from 36 medium and high quality studies were synthesized on 12 different intervention categories across three broad domains: health-focused, service coordination, and work modification interventions. There was strong evidence that duration away from work from both MSK or pain-related conditions and MH conditions were significantly reduced by multi-domain interventions encompassing at least two of the three domains. There was moderate evidence that these multi-domain interventions had a positive impact on cost outcomes. There was strong evidence that cognitive behavioural therapy interventions that do not also include workplace modifications or service coordination components are not effective in helping workers with MH conditions in RTW. Evidence for the effectiveness of other single-domain interventions was mixed, with some studies reporting positive effects and others reporting no effects on lost time and work functioning. Conclusions While there is substantial research literature focused on RTW, there are only a small number of quality workplace-based RTW intervention studies that involve workers with MSK or pain-related conditions and MH conditions. We recommend implementing multi-domain interventions (i.e. with healthcare provision, service coordination, and work accommodation components) to help reduce lost time for MSK or pain-related conditions and MH conditions. Practitioners should also consider implementing these programs to help improve work functioning and reduce costs associated with work disability.
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Affiliation(s)
- K L Cullen
- Institute for Work & Health, 481 University Ave, Toronto, ON, M5G 2E9, Canada.
| | - E Irvin
- Institute for Work & Health, 481 University Ave, Toronto, ON, M5G 2E9, Canada
| | - A Collie
- Institute for Safety Compensation and Recovery Research, Monash University, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - F Clay
- Institute for Safety Compensation and Recovery Research, Monash University, Melbourne, VIC, Australia
| | - U Gensby
- National Centre for Occupational Rehabilitation, Rauland, Norway
- Team WorkingLife ApS, Copenhagen, Denmark
| | - P A Jennings
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, VIC, Australia
| | - S Hogg-Johnson
- Institute for Work & Health, 481 University Ave, Toronto, ON, M5G 2E9, Canada
| | - V Kristman
- Institute for Work & Health, 481 University Ave, Toronto, ON, M5G 2E9, Canada
- Lakehead University, Thunder Bay, ON, Canada
| | - M Laberge
- University of Montreal and CHU Ste-Justine Research Centre, Montreal, QC, Canada
| | - D McKenzie
- Institute for Safety Compensation and Recovery Research, Monash University, Melbourne, VIC, Australia
| | - S Newnam
- Accident Research Centre, Monash University, Melbourne, VIC, Australia
| | - A Palagyi
- Institute for Safety Compensation and Recovery Research, Monash University, Melbourne, VIC, Australia
| | - R Ruseckaite
- Institute for Safety Compensation and Recovery Research, Monash University, Melbourne, VIC, Australia
| | - D M Sheppard
- Accident Research Centre, Monash University, Melbourne, VIC, Australia
| | - S Shourie
- Accident Research Centre, Monash University, Melbourne, VIC, Australia
| | - I Steenstra
- Institute for Work & Health, 481 University Ave, Toronto, ON, M5G 2E9, Canada
- Ted Rogers School of Management, Ryerson University, Toronto, ON, Canada
| | - D Van Eerd
- Institute for Work & Health, 481 University Ave, Toronto, ON, M5G 2E9, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - B C Amick
- Institute for Work & Health, 481 University Ave, Toronto, ON, M5G 2E9, Canada
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
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12
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Rothermund E, Michaelis M, Jarczok MN, Balint EM, Lange R, Zipfel S, Gündel H, Rieger MA, Junne F. Prevention of Common Mental Disorders in Employees. Perspectives on Collaboration from Three Health Care Professions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020278. [PMID: 29415515 PMCID: PMC5858347 DOI: 10.3390/ijerph15020278] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/01/2018] [Accepted: 02/04/2018] [Indexed: 11/25/2022]
Abstract
Collaboration among occupational health physicians, primary care physicians and psychotherapists in the prevention and treatment of common mental disorders in employees has been scarcely researched. To identify potential for improvement, these professions were surveyed in Baden-Württemberg (Germany). Four hundred and fifty occupational health physicians, 1000 primary care physicians and 700 resident medical and psychological psychotherapists received a standardized questionnaire about their experiences, attitudes and wishes regarding activities for primary, secondary and tertiary prevention of common mental disorders in employees. The response rate of the questionnaire was 30% (n = 133) among occupational health physicians, 14% (n = 136) among primary care physicians and 27% (n = 186) among psychotherapists. Forty percent of primary care physicians and 33% of psychotherapists had never had contact with an occupational health physician. Psychotherapists indicated more frequent contact with primary care physicians than vice versa (73% and 49%, respectively). Better cooperation and profession-specific training on mental disorders and better knowledge about work-related stress were endorsed. For potentially involved stakeholders, the importance of interdisciplinary collaboration for better prevention and care of employees with common mental disorders is very high. Nevertheless, there is only little collaboration in practice. To establish quality-assured cooperation structures in practice, participants need applicable frameworks on an organizational and legal level.
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Affiliation(s)
- Eva Rothermund
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, 89081 Ulm, Germany.
- Leadership Personality Centre Ulm, Ulm University, 89073 Ulm, Germany.
| | - Martina Michaelis
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, 72074 Tübingen, Germany.
- Research Centre for Occupational and Social Medicine (FFAS), 79098 Freiburg, Germany.
| | - Marc N Jarczok
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, 89081 Ulm, Germany.
| | - Elisabeth M Balint
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, 89081 Ulm, Germany.
| | - Rahna Lange
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, 72074 Tübingen, Germany.
| | - Stephan Zipfel
- Department of Internal Medicine VI, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, 72076 Tübingen, Germany.
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, 89081 Ulm, Germany.
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, 72074 Tübingen, Germany.
| | - Florian Junne
- Department of Internal Medicine VI, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, 72076 Tübingen, Germany.
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13
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Kenning C, Lovell K, Hann M, Agius R, Bee PE, Chew-Graham C, Coventry PA, van der Feltz-Cornelis CM, Gilbody S, Hardy G, Kellett S, Kessler D, McMillan D, Reeves D, Rick J, Sutton M, Bower P. Collaborative case management to aid return to work after long-term sickness absence: a pilot randomised controlled trial. PUBLIC HEALTH RESEARCH 2018. [DOI: 10.3310/phr06020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BackgroundDespite high levels of employment among working-age adults in the UK, there is still a significant minority who are off work with ill health at any one time (so-called ‘sickness absence’). Long-term sickness absence results in significant costs to the individual, to the employer and to wider society.ObjectiveThe overall objective of the intervention was to improve employee well-being with a view to aiding return to work. To meet this aim, a collaborative case management intervention was adapted to the needs of UK employees who were entering or experiencing long-term sickness absence.DesignA pilot randomised controlled trial, using permuted block randomisation. Recruitment of patients with long-term conditions in settings such as primary care was achieved by screening of routine records, followed by mass mailing of invitations to participants. However, the proportion of patients responding to such invitations can be low, raising concerns about external validity. Recruitment in the Case Management to Enhance Occupational Support (CAMEOS) study used this method to test whether or not it would transfer to a population with long-term sickness absence in the context of occupational health (OH).ParticipantsEmployed people on long-term sickness absence (between 4 weeks and 12 months). The pilot was run with two different collaborators: a large organisation that provided OH services for a number of clients and a non-profit community-based organisation.InterventionCollaborative case management was delivered by specially trained case managers from the host organisations. Sessions were delivered by telephone and supported use of a self-help handbook. The comparator was usual care as provided by participants’ general practitioner (GP) or OH provider. This varied for participants according to the services available to them. Neither participants nor the research team were blind to randomisation.Main outcome measuresRecruitment rates, intervention delivery and acceptability to participants were the main outcomes. Well-being, as measured by the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), and return-to-work rates were also recorded.ResultsIn total, over 1000 potentially eligible participants were identified across the sites and invited to participate. However, responses were received from just 61 of those invited (5.5%), of whom 16 (1.5%) were randomised to the trial (seven to treatment, nine to control). Detailed information on recruitment methods, intervention delivery, engagement and acceptability is presented. No harms were reported in either group.ConclusionsThis pilot study faced a number of barriers, particularly in terms of recruitment of employers to host the research. Our ability to respond to these challenges faced several barriers related to the OH context and the study set up. The intervention seemed feasible and acceptable when delivered, although caution is required because of the small number of randomised participants. However, employees’ lack of engagement in the research might imply that they did not see the intervention as valuable.Future workDeveloping effective and acceptable ways of reducing sickness absence remains a high priority. We discuss possible ways of overcoming these challenges in the future, including incentives for employers, alternative study designs and further modifications to recruitment methods.Trial registrationCurrent Controlled Trials ISRCTN33560198.FundingThis project was funded by the NIHR Public Health Research programme and will be published in full inPublic Health Research; Vol. 6, No. 2. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Cassandra Kenning
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Karina Lovell
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Mark Hann
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Raymond Agius
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
| | - Penny E Bee
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | | | | | | | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | - Gillian Hardy
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Stephen Kellett
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - David Kessler
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK
| | - David Reeves
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Joanne Rick
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Matthew Sutton
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Peter Bower
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
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14
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Goorden M, van der Feltz-Cornelis CM, van Steenbergen-Weijenburg KM, Horn EK, Beekman AT, Hakkaart-van Roijen L. Cost-utility of collaborative care for the treatment of comorbid major depressive disorder in outpatients with chronic physical conditions. A randomized controlled trial in the general hospital setting (CC-DIM). Neuropsychiatr Dis Treat 2017; 13:1881-1893. [PMID: 28765710 PMCID: PMC5525903 DOI: 10.2147/ndt.s134008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Major depressive disorder (MDD) is highly prevalent in patients with a chronic physical condition, and this comorbidity has a negative influence on quality of life, health care costs, self-care, morbidity, and mortality. Research has shown that collaborative care (CC) may be a cost-effective treatment. However, its cost-effectiveness in this patient group has not yet been established. Therefore, the aim of this study was to evaluate the cost-utility of CC for the treatment of comorbid MDD in chronically ill patients in the outpatient general hospital setting. The study was conducted from a health care and societal perspective. PATIENTS AND METHODS In this randomized controlled trial, 81 patients with moderate-to-severe MDD were included; 42 were randomly assigned to the CC group and 39 to the care as usual (CAU) group. We applied the TiC-P, short-form Health-Related Quality of Life questionnaire, and EuroQol EQ-5D 3 level version, measuring the use of health care, informal care, and household work, respectively, at baseline and at 3, 6, 9, and 12 months follow-up. RESULTS The mean annual direct medical costs in the CC group were €6,718 (95% confidence interval [CI]: 3,541 to 10,680) compared to €4,582 (95% CI: 2,782 to 6,740) in the CAU group. The average quality-adjusted life years (QALYs) gained were 0.07 higher in the CC group, indicating that CC is more costly but also more effective than CAU. From a societal perspective, the incremental cost-effectiveness ratio was €24,690/QALY. CONCLUSION This first cost-utility analysis in chronically ill patients with comorbid MDD shows that CC may be a cost-effective treatment depending on willingness-to-pay levels. Nevertheless, the low utility scores emphasize the need for further research to improve the cost-effectiveness of CC in this highly prevalent and costly group of patients.
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Affiliation(s)
- Maartje Goorden
- Institute of Health Policy and Management (iBMG)/Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam
| | | | | | - Eva K Horn
- Viersprong Institute for Studies on Personality Disorders, Halsteren
| | - Aartjan Tf Beekman
- Department of Psychiatry.,EMGO+ Research Institute VUmc, VU University Medical Centre, Amsterdam, the Netherlands
| | - Leona Hakkaart-van Roijen
- Institute of Health Policy and Management (iBMG)/Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam
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15
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Rothermund E, Gündel H, Rottler E, Hölzer M, Mayer D, Rieger M, Kilian R. Effectiveness of psychotherapeutic consultation in the workplace: a controlled observational trial. BMC Public Health 2016; 16:891. [PMID: 27566672 PMCID: PMC5002128 DOI: 10.1186/s12889-016-3567-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 08/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study compares the effectiveness of psychotherapeutic consultation in the workplace (PSIW) with psychotherapeutic outpatient care (PSOC) in Germany. METHODS Work ability (WAI), quality of life (SF-12), clinical symptoms (PHQ) and work-related stress (MBI, IS) were assessed in 367 patients seeking mental health care via two routes (PSIW n = 174; PSOC n = 193) before consultation and 12 weeks later. Changes in outcome variables were assessed using covariance analysis with repeated measures (ANCOVA) with sociodemographic variables (propensity score method), therapy dose, setting and symptom severity as covariates. RESULTS The PSIW and PSOC groups included 122 and 66 men respectively. There were 102 first-time users of mental healthcare in the PSIW group and 83 in the PSOC group. There were group differences in outcome variables at baseline (p < 0.05); PSIW patients were less impaired overall. There were no group difference in sociodemographic variables, number of sessions within the offer or symptom severity. There was no main effect of group on outcome variables and no group*time interaction. Work-related stress indicators did not change during the intervention, but work ability improved in both groups (F = 10.149, p = 0.002; baseline M = 27.2, SD = 8.85); follow-up M = 28.6, SD = 9.02), as did perceived mental health (SF-12 MCS), depression (PHQ-9) and anxiety (PHQ-7). Effect sizes were between η(2) = 0.028 and η(2) = 0.040. CONCLUSIONS Psychotherapeutic consultation is similarly effective in improving patients' functional and clinical status whether delivered in the workplace or in an outpatient clinic. Offering mental health services in the workplace makes it easier to reach patients at an earlier stage in their illness and thus enables provision of early and effective mental health care. TRIAL REGISTRATION DRKS00003184 , retrospectively registered 13 January 2012.
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Affiliation(s)
- Eva Rothermund
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Edit Rottler
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Michael Hölzer
- ZfP Suedwuerttemberg, Sonnenbergklinik, 70597 Stuttgart, Germany
| | - Dorothea Mayer
- Health and Safety Sindelfingen, Daimler AG, 71059 Sindelfingen, Germany
| | - Monika Rieger
- Institute for Occupational and Social Medicine and Health Services Research, University Clinic Tuebingen, Competence Centre Health Services Research, Medical Faculty Tuebingen, 72074 Tuebingen, Germany
| | - Reinhold Kilian
- Department of Psychiatry II, University Hospital Ulm, BKH Guenzburg, 89312 Guenzburg, Germany
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van Vilsteren M, van Oostrom SH, de Vet HCW, Franche R, Boot CRL, Anema JR. Workplace interventions to prevent work disability in workers on sick leave. Cochrane Database Syst Rev 2015; 2015:CD006955. [PMID: 26436959 PMCID: PMC9297123 DOI: 10.1002/14651858.cd006955.pub3] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Work disability has serious consequences for individuals as well as society. It is possible to facilitate resumption of work by reducing barriers to return to work (RTW) and promoting collaboration with key stakeholders. This review was first published in 2009 and has now been updated to include studies published up to February 2015. OBJECTIVES To determine the effectiveness of workplace interventions in preventing work disability among sick-listed workers, when compared to usual care or clinical interventions. SEARCH METHODS We searched the Cochrane Work Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO databases on 2 February 2015. SELECTION CRITERIA We included randomised controlled trials (RCTs) of workplace interventions that aimed to improve RTW for disabled workers. We only included studies where RTW or conversely sickness absence was reported as a continuous outcome. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias of the studies. We performed meta-analysis where possible, and we assessed the quality of evidence according to GRADE criteria. We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 14 RCTs with 1897 workers. Eight studies included workers with musculoskeletal disorders, five workers with mental health problems, and one workers with cancer. We judged six studies to have low risk of bias for the outcome sickness absence.Workplace interventions significantly improved time until first RTW compared to usual care, moderate-quality evidence (hazard ratio (HR) 1.55, 95% confidence interval (CI) 1.20 to 2.01). Workplace interventions did not considerably reduce time to lasting RTW compared to usual care, very low-quality evidence (HR 1.07, 95% CI 0.72 to 1.57). The effect on cumulative duration of sickness absence showed a mean difference of -33.33 (95% CI -49.54 to -17.12), favouring the workplace intervention, high-quality evidence. One study assessed recurrences of sick leave, and favoured usual care, moderate-quality evidence (HR 0.42, 95% CI 0.21 to 0.82). Overall, the effectiveness of workplace interventions on work disability showed varying results.In subgroup analyses, we found that workplace interventions reduced time to first and lasting RTW among workers with musculoskeletal disorders more than usual care (HR 1.44, 95% CI 1.15 to 1.82 and HR 1.77, 95% CI 1.37 to 2.29, respectively; both moderate-quality evidence). In studies of workers with musculoskeletal disorders, pain also improved (standardised mean difference (SMD) -0.26, 95% CI -0.47 to -0.06), as well as functional status (SMD -0.33, 95% CI -0.58 to -0.08). In studies of workers with mental health problems, there was a significant improvement in time until first RTW (HR 2.64, 95% CI 1.41 to 4.95), but no considerable reduction in lasting RTW (HR 0.79, 95% CI 0.54 to 1.17). One study of workers with cancer did not find a considerable reduction in lasting RTW (HR 0.88, 95% CI 0.53 to 1.47).In another subgroup analysis, we did not find evidence that offering a workplace intervention in combination with a cognitive behavioural intervention (HR 1.93, 95% CI 1.27 to 2.93) is considerably more effective than offering a workplace intervention alone (HR 1.35, 95% CI 1.01 to 1.82, test for subgroup differences P = 0.17).Workplace interventions did not considerably reduce time until first RTW compared with a clinical intervention in workers with mental health problems in one study (HR 2.65, 95% CI 1.42 to 4.95, very low-quality evidence). AUTHORS' CONCLUSIONS We found moderate-quality evidence that workplace interventions reduce time to first RTW, high-quality evidence that workplace interventions reduce cumulative duration of sickness absence, very low-quality evidence that workplace interventions reduce time to lasting RTW, and moderate-quality evidence that workplace interventions increase recurrences of sick leave. Overall, the effectiveness of workplace interventions on work disability showed varying results. Workplace interventions reduce time to RTW and improve pain and functional status in workers with musculoskeletal disorders. We found no evidence of a considerable effect of workplace interventions on time to RTW in workers with mental health problems or cancer.We found moderate-quality evidence to support workplace interventions for workers with musculoskeletal disorders. The quality of the evidence on the effectiveness of workplace interventions for workers with mental health problems and cancer is low, and results do not show an effect of workplace interventions for these workers. Future research should expand the range of health conditions evaluated with high-quality studies.
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Affiliation(s)
- Myrthe van Vilsteren
- VU University Medical CenterDepartment of Public and Occupational Health, EMGO Institute for Health and Care ResearchPO Box 7057AmsterdamNetherlands1007 MB
| | - Sandra H van Oostrom
- National Institute for Public Health and the EnvironmentCentre for Nutrition, Prevention and Health ServicesBilthovenNetherlands
| | - Henrica CW de Vet
- VU University Medical CenterDepartment of Epidemiology and Biostatistics, EMGO Institute for Health and Care ResearchPO Box 7057AmsterdamNetherlands1007 MB
| | | | - Cécile RL Boot
- EMGO Institute for Health and Care Research, VU University Medical CenterDepartment of Public and Occupational HealthAmsterdamNetherlands
| | - Johannes R Anema
- VU University Medical CenterDepartment of Public and Occupational Health, EMGO Institute for Health and Care ResearchPO Box 7057AmsterdamNetherlands1007 MB
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Volker D, Zijlstra-Vlasveld MC, Anema JR, Beekman AT, Brouwers EP, Emons WH, van Lomwel AGC, van der Feltz-Cornelis CM. Effectiveness of a blended web-based intervention on return to work for sick-listed employees with common mental disorders: results of a cluster randomized controlled trial. J Med Internet Res 2015; 17:e116. [PMID: 25972279 PMCID: PMC4468600 DOI: 10.2196/jmir.4097] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 03/15/2015] [Accepted: 03/16/2015] [Indexed: 12/17/2022] Open
Abstract
Background Common mental disorders are strongly associated with long-term sickness absence, which has negative consequences for the individual employee’s quality of life and leads to substantial costs for society. It is important to focus on return to work (RTW) during treatment of sick-listed employees with common mental disorders. Factors such as self-efficacy and the intention to resume work despite having symptoms are important in the RTW process. We developed “E-health module embedded in Collaborative Occupational health care” (ECO) as a blended Web-based intervention with 2 parts: an eHealth module (Return@Work) for the employee aimed at changing cognitions of the employee regarding RTW and a decision aid via email supporting the occupational physician with advice regarding treatment and referral options based on monitoring the employee’s progress during treatment. Objective This study evaluated the effect of a blended eHealth intervention (ECO) versus care as usual on time to RTW of sick-listed employees with common mental disorders. Methods The study was a 2-armed cluster randomized controlled trial. Employees sick-listed between 4 and 26 weeks with common mental disorder symptoms were recruited by their occupational health service or employer. The employees were followed up to 12 months. The primary outcome measures were time to first RTW (partial or full) and time to full RTW. Secondary outcomes were response and remission of the common mental disorder symptoms (self-assessed). Results A total of 220 employees were included: 131 participants were randomized to the ECO intervention and 89 to care as usual (CAU). The duration until first RTW differed significantly between the groups. The median duration was 77.0 (IQR 29.0-152.3) days in the CAU group and 50.0 (IQR 20.8-99.0) days in the ECO group (hazard ratio [HR] 1.390, 95% CI 1.034-1.870, P=.03). No significant difference was found for duration until full RTW. Treatment response of common mental disorder symptoms did not differ significantly between the groups, but at 9 months after baseline significantly more participants in the ECO group achieved remission than in the CAU group (OR 2.228, 95% CI 1.115-4.453, P=.02). Conclusions The results of this study showed that in a group of sick-listed employees with common mental disorders, applying the blended eHealth ECO intervention led to faster first RTW and more remission of common mental disorder symptoms than CAU. Trial Registration Netherlands Trial Register NTR2108; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2108. (Archived by WebCite at http://www.webcitation.org/6YBSnNx3P).
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Affiliation(s)
- Daniëlle Volker
- Trimbos Institute, Netherlands institute of mental health and addiction, Utrecht, Netherlands.
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Goorden M, Vlasveld MC, Anema JR, van Mechelen W, Beekman ATF, Hoedeman R, van der Feltz-Cornelis CM, Hakkaart-van Roijen L. Cost-utility analysis of a collaborative care intervention for major depressive disorder in an occupational healthcare setting. JOURNAL OF OCCUPATIONAL REHABILITATION 2014; 24:555-62. [PMID: 24085535 DOI: 10.1007/s10926-013-9483-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
PURPOSE Major depression is associated with high levels of absence and reduced productivity. Therefore the costs to society are high. The aim of this study was to evaluate the cost-utility of collaborative care for major depressive disorder (MDD) compared to care as usual in an occupational healthcare setting. A societal perspective was taken. METHODS In this randomised controlled trial, 126 sick-listed workers with MDD were included (65 collaborative care, 61 care as usual). Baseline measurements and follow up measures (3, 6, 9 and 12 months) were assessed by questionnaire. We applied the Trimbos/iMTA questionnaire for costs associated with psychiatric illness, the SF-HQL and the EQ-5D respectively measuring the health care utilization, production losses and general health related quality of life. RESULTS The average annual healthcare costs in the collaborative care group were €3,874 (95 % CI €2,778-€ 5,718) compared to €4,583 (95 % CI €3,108-€6,794) in the care as usual group. The average quality of life years (QALY's) gained were lower in the collaborative care group, 0.05 QALY. The majority of the ICERS (69 %) indicate that collaborative care is less costly but also less effective than care as usual. Including the productivity costs did not change this result. CONCLUSIONS The cost-utility analysis showed that collaborative care generated reduced costs and a reduction in effects compared to care as usual and was therefore not a cost-effective intervention.
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Affiliation(s)
- Maartje Goorden
- Institute for Medical Technology Assessment, Institute of Health Policy and Management, Burgermeester Oudlaan 50, PO Box 1738, 3000 DR, Rotterdam, The Netherlands,
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Yoshitsugu K, Kuroda Y, Hiroyama Y, Nagano N. Concise set of files for smooth return to work in employees with mental disorders. SPRINGERPLUS 2013; 2:630. [PMID: 24312746 PMCID: PMC3851525 DOI: 10.1186/2193-1801-2-630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 11/21/2013] [Indexed: 12/05/2022]
Abstract
Sick leave due to mental disorders is a societal problem. It carries a high cost in terms of loss of labor productivity and absenteeism. Partial remission increases the risk of relapse after a return to work. There is sometimes a difference between the ability to return to work as judged by a general practitioner (GP) and the needs of the workplace. GPs are the main controllers of treatment and tend to protect their patients. Communication and agreement by GPs and occupational physicians play an effective role in the return to work. However, it requires considerable effort for both of them to make time to do this. We have developed a concise set of files for a smooth return to work. The files consist of three parts: “Suggestions for corresponding with employees taking sick leave”; “Checklist for smooth return to work”; and “Pattern of living”. We put them into practice among 20 companies in Japan from January 2012 to October 2013. The companies had 8244 workers in total and 116 workers were on sick-leave due to mental disorders. Our set of files contributed to sharing the written basic policy of return to work among employees on sick leave with mental disorders, GPs, occupational physicians and personnel officers. That sharing led to facilitating a smooth return to work. Although there are differences in the legal and medical systems between Japan and other countries, our concept of sharing the written basic policy may give some help to occupational physicians in other parts of the world as well.
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Bouwmans C, De Jong K, Timman R, Zijlstra-Vlasveld M, Van der Feltz-Cornelis C, Tan Swan S, Hakkaart-van Roijen L. Feasibility, reliability and validity of a questionnaire on healthcare consumption and productivity loss in patients with a psychiatric disorder (TiC-P). BMC Health Serv Res 2013; 13:217. [PMID: 23768141 PMCID: PMC3694473 DOI: 10.1186/1472-6963-13-217] [Citation(s) in RCA: 265] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 06/06/2013] [Indexed: 12/12/2022] Open
Abstract
Background Patient self-report allows collecting comprehensive data for the purpose of performing economic evaluations. The aim of the current study was to assess the feasibility, reliability and a part of the construct validity of a commonly applied questionnaire on healthcare utilization and productivity losses in patients with a psychiatric disorder (TiC-P). Methods Data were derived alongside two clinical trials performed in the Netherlands in patients with mental health problems. The response rate, average time of filling out the questionnaire and proportions of missing values were used as indicators of feasibility of the questionnaire. Test-retest analyses were performed including Cohen’s kappa and intra class correlation coefficients to assess reliability of the data. The construct validity was assessed by comparing patient reported data on contacts with psychotherapists and reported data on long-term absence from work with data derived from registries. Results The response rate was 72%. The mean time needed for filling out the first TiC-P was 9.4 minutes. The time needed for filling out the questionnaire was 2.3 minutes less for follow up measurements. Proportions of missing values were limited (< 2.4%) except for medication for which in 10% of the cases costs could not be calculated. Cohen’s kappa was satisfactory to almost perfect for most items related to healthcare consumption and satisfactory for items on absence from work and presenteeism. Comparable results were shown by the ICCs on variables measuring volumes of medical consumption and productivity losses indicating good reliability of the questionnaire. Absolute agreement between patient-reported data and data derived from medical registrations of the psychotherapists was satisfactory. Accepting a margin of +/− seven days, the agreement on reported and registered data on long-term absence from work was satisfactory. The validity of self-reported data using the TiC-P is promising. Conclusions The results indicate that the TiC-P is a feasible and reliable instrument for collecting data on medical consumption and productivity losses in patients with mild to moderate mental health problems. Additionally, the construct validity of questions related to contacts with psychotherapist and long-term absence from work was satisfactory.
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Affiliation(s)
- Clazien Bouwmans
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
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de Heer EW, Dekker J, van Eck van der Sluijs JF, Beekman ATF, van Marwijk HWJ, Holwerda TJ, Bet PM, Roth J, Hakkaart-Van Roijen L, Ringoir L, Kat F, van der Feltz-Cornelis CM. Effectiveness and cost-effectiveness of transmural collaborative care with consultation letter (TCCCL) and duloxetine for major depressive disorder (MDD) and (sub)chronic pain in collaboration with primary care: design of a randomized placebo-controlled multi-Centre trial: TCC:PAINDIP. BMC Psychiatry 2013; 13:147. [PMID: 23705849 PMCID: PMC3698098 DOI: 10.1186/1471-244x-13-147] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 05/11/2013] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The comorbidity of pain and depression is associated with high disease burden for patients in terms of disability, wellbeing, and use of medical care. Patients with major and minor depression often present themselves with pain to a general practitioner and recognition of depression in such cases is low, but evolving. Also, physical symptoms, including pain, in major depressive disorder, predict a poorer response to treatment. A multi-faceted, patient-tailored treatment programme, like collaborative care, is promising. However, treatment of chronic pain conditions in depressive patients has, so far, received limited attention in research. Cost effectiveness of an integrated approach of pain in depressed patients has not been studied. METHODS/DESIGN This study is a placebo controlled double blind, three armed randomized multi centre trial. Patients with (sub)chronic pain and a depressive disorder are randomized to either a) collaborative care with duloxetine, b) collaborative care with placebo or c) duloxetine alone. 189 completers are needed to attain sufficient power to show a clinically significant effect of 0.6 SD on the primary outcome measures (PHQ-9 score). Data on depression, anxiety, mental and physical health, medication adherence, medication tolerability, quality of life, patient-doctor relationship, coping, health resource use and productivity will be collected at baseline and after three, six, nine and twelve months. DISCUSSION This study enables us to show the value of a closely monitored integrated treatment model above usual pharmacological treatment. Furthermore, a comparison with a placebo arm enables us to evaluate effectiveness of duloxetine in this population in a real life setting. Also, this study will provide evidence-based treatments and tools for their implementation in practice. This will facilitate generalization and implementation of results of this study. Moreover, patients included in this study are screened for pain symptoms, differentiating between nociceptive and neuropathic pain. Therefore, pain relief can be thoroughly evaluated. TRIAL REGISTRATION NTR1089.
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Affiliation(s)
- Eric W de Heer
- Netherlands Institute of Mental Health and Addiction (Trimbos-institute), Utrecht, The Netherlands
- Tilburg School of Behavioral and Social Sciences, Tranzo Department, University of Tilburg, Tilburg, The Netherlands
- TopClinical Centre for Body, Mind and Health, GGz Breburg, Tilburg, The Netherlands
| | - Jack Dekker
- Arkin, Mental Health Institute, Amsterdam, The Netherlands
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - Jonna F van Eck van der Sluijs
- Tilburg School of Behavioral and Social Sciences, Tranzo Department, University of Tilburg, Tilburg, The Netherlands
- TopClinical Centre for Body, Mind and Health, GGz Breburg, Tilburg, The Netherlands
| | - Aartjan TF Beekman
- The EMGO Institute for health and care research (EMGO+), Amsterdam, The Netherlands
- Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands
- GGz inGeest, Mental Health Institute, Amsterdam, The Netherlands
| | - Harm WJ van Marwijk
- The EMGO Institute for health and care research (EMGO+), Amsterdam, The Netherlands
- Department of General Practice, VU University Medical Centre, Amsterdam, The Netherlands
| | | | - Pierre M Bet
- Department of Clinical Pharmacology and Pharmacy, VU University Medical Centre, Amsterdam, The Netherlands
| | - Joost Roth
- GGz inGeest, Mental Health Institute, Amsterdam, The Netherlands
| | | | - Lianne Ringoir
- Tilburg School of Behavioral and Social Sciences, Department of Medical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Fiona Kat
- Arkin, Mental Health Institute, Amsterdam, The Netherlands
| | - Christina M van der Feltz-Cornelis
- Netherlands Institute of Mental Health and Addiction (Trimbos-institute), Utrecht, The Netherlands
- Tilburg School of Behavioral and Social Sciences, Tranzo Department, University of Tilburg, Tilburg, The Netherlands
- TopClinical Centre for Body, Mind and Health, GGz Breburg, Tilburg, The Netherlands
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Abstract
PURPOSE OF REVIEW The purpose of this study is to review recent evidence of the effects of enhanced depression care, focusing (1) on symptomatic, functional and economic outcomes and (2) across different countries, (3) ethnic groups and (4) settings. RECENT FINDINGS Collaborative care is currently by far the most influential and best studied method to enhance depression care. Recent trials and reviews provide firm evidence that collaborative care is more effective than care as usual (CAU), though with small effects. These effects generalized across several important health outcomes are probably more pronounced in patients with more complex or severe disorders. Cost-effectiveness and cost utility data demonstrate that collaborative care is of good value for money, and this is probably more pronounced in patients with higher a-priori levels of healthcare utilization. Collaborative care is readily exported to other healthcare systems, other regions of the world and other cultures. SUMMARY Given parallel development and successful testing of other cheaper and more simple interventions targeting depression (such as guided self-help and e-mental health), it may be that collaborative care will focus on the more severe, complex or recurrent forms of affective disorder in the future. Including effects of collaborative care on other outcomes, especially on work-related functioning and economic productivity, seems fruitful.
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Vemer P, Bouwmans CA, Zijlstra-Vlasveld MC, van der Feltz-Cornelis CM, Hakkaart-van Roijen L. Let's get back to work: survival analysis on the return-to-work after depression. Neuropsychiatr Dis Treat 2013; 9:1637-45. [PMID: 24187499 PMCID: PMC3810438 DOI: 10.2147/ndt.s49883] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Absence from work due to mental disorders is substantial. Additionally, long-term absence from work is associated with a reduced probability of return-to-work (RTW). Major depressive disorder (MDD) is a prevalent condition in Dutch occupational health care settings. An early estimate of the prognosis regarding RTW in patients with MDD could serve both as a point of departure for the identification of high-risk cases and as an instrument to monitor the course of the disorder and of RTW. In the current study, we aimed to assess the added value of health-related quality of life (HRQoL) and severity of depression to predict the time to RTW. PATIENTS AND METHODS Data were derived from a prospective longitudinal study aimed to evaluate the cost effectiveness of a collaborative care treatment in sick-listed workers with MDD. We included demographic, job-related, and health-related variables. Severity of depression was measured using the Patient Health Questionnaire Depression Scale-9 (PHQ-9). HRQoL was measured using two generic preference-based instruments, the EuroQol 5-Dimension (EQ-5D™) and the Medical Outcomes Study Short Form Health Survey (SF-36). A survival model was constructed by applying different survival functions to assess the best fit for the data. Additionally, survival analyses were performed to assess the added value of the two HRQoL measures and depression severity for predicting RTW. RESULTS Females and older patients had a longer time to RTW. The same was true for patients with a full-time job and patients with more decision latitude. Patients in a management position and patients with more social support had a shorter time to RTW. Severity of depression was not predictive for the time to RTW. HRQoL measured by the SF-36 was a significant predictor for the time to RTW. CONCLUSION HRQoL emerged as a significant predictor for the time to RTW. However, severity of depression was not predictive for the time to RTW. These results suggest the importance of assessing HRQoL in addition to severity of disease to assess functionality.
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Affiliation(s)
- Pepijn Vemer
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam
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Volker D, Vlasveld MC, Anema JR, Beekman AT, Roijen LHV, Brouwers EP, van Lomwel AGC, van der Feltz-Cornelis CM. Blended E-health module on return to work embedded in collaborative occupational health care for common mental disorders: design of a cluster randomized controlled trial. Neuropsychiatr Dis Treat 2013; 9:529-37. [PMID: 23637534 PMCID: PMC3639217 DOI: 10.2147/ndt.s43969] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Common mental disorders (CMD) have a major impact on both society and individual workers, so return to work (RTW) is an important issue. In The Netherlands, the occupational physician plays a central role in the guidance of sick-listed workers with respect to RTW. Evidence-based guidelines are available, but seem not to be effective in improving RTW in people with CMD. An intervention supporting the occupational physician in guidance of sick-listed workers combined with specific guidance regarding RTW is needed. A blended E-health module embedded in collaborative occupational health care is now available, and comprises a decision aid supporting the occupational physician and an E-health module, Return@Work, to support sick-listed workers in the RTW process. The cost-effectiveness of this intervention will be evaluated in this study and compared with that of care as usual. METHODS This study is a two-armed cluster randomized controlled trial, with randomization done at the level of occupational physicians. Two hundred workers with CMD on sickness absence for 4-26 weeks will be included in the study. Workers whose occupational physician is allocated to the intervention group will receive the collaborative occupational health care intervention. Occupational physicians allocated to the care as usual group will give conventional sickness guidance. Follow-up assessments will be done at 3, 6, 9, and 12 months after baseline. The primary outcome is duration until RTW. The secondary outcome is severity of symptoms of CMD. An economic evaluation will be performed as part of this trial. CONCLUSION It is hypothesized that collaborative occupational health care intervention will be more (cost)-effective than care as usual. This intervention is innovative in its combination of a decision aid by email sent to the occupational physician and an E-health module aimed at RTW for the sick-listed worker.
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Affiliation(s)
- Daniëlle Volker
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht ; Tranzo Department, Tilburg University, Tilburg
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Berger M, Schneller C, Maier W. Arbeit, psychische Erkrankungen und Burn-out. DER NERVENARZT 2012; 83:1364-72. [PMID: 23104598 DOI: 10.1007/s00115-012-3582-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- M Berger
- Abteilung für Psychiatrie und Psychotherapie, Universitätsklinik, Albrecht-Ludwigs-Universität Freiburg, Hauptstr. 5, 79104 Freiburg, Deutschland.
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Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, Dickens C, Coventry P. Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev 2012; 10:CD006525. [PMID: 23076925 DOI: 10.1002/14651858.cd006525.pub2] [Citation(s) in RCA: 465] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Common mental health problems, such as depression and anxiety, are estimated to affect up to 15% of the UK population at any one time, and health care systems worldwide need to implement interventions to reduce the impact and burden of these conditions. Collaborative care is a complex intervention based on chronic disease management models that may be effective in the management of these common mental health problems. OBJECTIVES To assess the effectiveness of collaborative care for patients with depression or anxiety. SEARCH METHODS We searched the following databases to February 2012: The Cochrane Collaboration Depression, Anxiety and Neurosis Group (CCDAN) trials registers (CCDANCTR-References and CCDANCTR-Studies) which include relevant randomised controlled trials (RCTs) from MEDLINE (1950 to present), EMBASE (1974 to present), PsycINFO (1967 to present) and the Cochrane Central Register of Controlled Trials (CENTRAL, all years); the World Health Organization (WHO) trials portal (ICTRP); ClinicalTrials.gov; and CINAHL (to November 2010 only). We screened the reference lists of reports of all included studies and published systematic reviews for reports of additional studies. SELECTION CRITERIA Randomised controlled trials (RCTs) of collaborative care for participants of all ages with depression or anxiety. DATA COLLECTION AND ANALYSIS Two independent researchers extracted data using a standardised data extraction sheet. Two independent researchers made 'Risk of bias' assessments using criteria from The Cochrane Collaboration. We combined continuous measures of outcome using standardised mean differences (SMDs) with 95% confidence intervals (CIs). We combined dichotomous measures using risk ratios (RRs) with 95% CIs. Sensitivity analyses tested the robustness of the results. MAIN RESULTS We included seventy-nine RCTs (including 90 relevant comparisons) involving 24,308 participants in the review. Studies varied in terms of risk of bias.The results of primary analyses demonstrated significantly greater improvement in depression outcomes for adults with depression treated with the collaborative care model in the short-term (SMD -0.34, 95% CI -0.41 to -0.27; RR 1.32, 95% CI 1.22 to 1.43), medium-term (SMD -0.28, 95% CI -0.41 to -0.15; RR 1.31, 95% CI 1.17 to 1.48), and long-term (SMD -0.35, 95% CI -0.46 to -0.24; RR 1.29, 95% CI 1.18 to 1.41). However, these significant benefits were not demonstrated into the very long-term (RR 1.12, 95% CI 0.98 to 1.27).The results also demonstrated significantly greater improvement in anxiety outcomes for adults with anxiety treated with the collaborative care model in the short-term (SMD -0.30, 95% CI -0.44 to -0.17; RR 1.50, 95% CI 1.21 to 1.87), medium-term (SMD -0.33, 95% CI -0.47 to -0.19; RR 1.41, 95% CI 1.18 to 1.69), and long-term (SMD -0.20, 95% CI -0.34 to -0.06; RR 1.26, 95% CI 1.11 to 1.42). No comparisons examined the effects of the intervention on anxiety outcomes in the very long-term.There was evidence of benefit in secondary outcomes including medication use, mental health quality of life, and patient satisfaction, although there was less evidence of benefit in physical quality of life. AUTHORS' CONCLUSIONS Collaborative care is associated with significant improvement in depression and anxiety outcomes compared with usual care, and represents a useful addition to clinical pathways for adult patients with depression and anxiety.
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Affiliation(s)
- Janine Archer
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
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Gilbody S, Bower P, Rick J. Better care for depression in the workplace: integrating occupational and mental health services. Br J Psychiatry 2012; 200:442-3. [PMID: 22661675 DOI: 10.1192/bjp.bp.111.103598] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
People with depression in the workplace are less productive and at risk of losing their job. Many never work again. Intervention should ideally begin before sickness absence occurs and early return to work should be the focus of care. This will require closer integration of primary care, mental health and occupational health services.
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