Return to work after work-related stress: a randomized controlled trial of a work-focused cognitive behavioral intervention

• Published in: Scandinavian Journal of Work, Environment ＆ Health Vol. 43; no. 5; pp. 436 - 446
• Main Authors: Dalgaard, Vita Ligaya, Aschbacher, Kirstin, Andersen, Johan Hviid, Glasscock, David John, Willert, Morten Vejs, Carstensen, Ole, Biering, Karin
• Format: Journal Article
• Language: English
• Published: Finland Scandinavian Journal of Work, Environment ＆ Health 01.09.2017; Nordic Association of Occupational Safety and Health; Scandinavian Journal of Work, Environment & Health; Nordic Association of Occupational Safety and Health (NOROSH)
• Subjects: Absenteeism; Adjustment; Adjustment Disorders - psychology; Adult; Behavior modification; Cardiovascular disease; cbt; Clinical trials; Cognition; Cognitive ability; cognitive behavioral intervention; cognitive behavioral therapy; Cognitive psychology; Cognitive therapy; Cognitive Therapy - methods; Confidence intervals; Control groups; Coping; Denmark; Employee benefits; Female; Humans; Intervention; Job stress; Male; Mental depression; Mental disorders; Mental health; mental health problem; Middle Aged; Municipalities; Occupational health; Occupational stress; Occupational Stress - psychology; Occupational Stress - rehabilitation; Patients; perceived stress; Psychoeducational intervention; Psychological stress; Public health; Questionnaires; Randomization; randomized controlled trial; rct; Regression analysis; Regression models; rehabilitation; Return to Work; rtw; Sick leave; Sick Leave - statistics & numerical data; Sleep; Stress; stress management; Stresses; Time Factors; Unemployment; Work environment; work stress; work-related stress; Workplace - psychology; Workplaces; Denmark; cognitive behavioral therapy; RCT; cognition; perceived stress; mental health problem; sick leave; sleep; absenteeism; rehabilitation; CBT; RTW; work stress; stress management
• ISSN: 0355-3140; 1795-990X
• DOI: 10.5271/sjweh.3655

Objectives: This study aimed to evaluate the effect of a stress management intervention (SMI) on lasting return to work (RTW) among patients with work-related stress complaints. Methods: Sickness benefit departments from three local municipalities referred patients on sick leave with work-related adjustment disorders or mild depression to the Department of Occupational Medicine, Regional Hospital West Jutland. A 2× randomization procedure allocated patients into one of three groups: intervention (N=58), control A (which received a clinical assessment; N=56), or control B (no assessment; N=49). Treatment comprised individual work-focused cognitive behavioral therapy (CBT) with an optional workplace intervention. The outcome was time until lasting RTW (16 and 44 weeks follow-up) using register data. Results: Median number of weeks until lasting RTW was 15, 19, and 32 for the intervention group, control A, and control B respectively. However, for group B, clinical assessment was not part of the inclusion process, which may have introduced selection bias. In the fully-adjusted Cox regression model, the intervention group exhibited significantly faster lasting RTW at 44 weeks; hazard ratio (HR) 1.57 [95% confidence interval (95% CI) 1.01-2.44] relative to control group A, with a non-significant trend evident at 16 weeks; HR 1.70 (95% CI 0.94- 3.10), when controlling for age, gender, occupation, sick leave during previous year, full or partial sick leave, and diagnosis. Unadjusted analyses remained directionally consistent but were reduced to marginal significance. Conclusions: There was a tendency towards faster lasting RTW in the intervention group compared to control A, which received clinical assessment, in all analyses. The intervention group returned to work about 4 weeks earlier than control A, which could translate into substantial financial gains.