Effect of guideline adherence on return to work. Preliminary results of a prospective cohort study among employees with psychological complaints. Jenny Huijs, Roland Blonk, Shirley Oomens

Contents presentation Problem description Aim of study Method Results Conclusion Questions & Discussion

Problem description Incidence of mental health problems Work-related consequences What do we know:  Activation interventions with a (early) focus on work are effective  Mainly interventions by OP among employees with mild disorders Development guideline ‘Work and psychological complaints, a guideline for psychologists’

Aim of the study To examine the effects of guideline adherence by psychologists on RTW and psychological complaints among employees on sick leave due to common mental health disorders.

Method (1) Prospective cohort study with one-year follow-up National recruitment of psychologists  Recruitment of clients (employees, sick leave) Method of measure  Questionnaires (baseline, 3, 6, 12 months)  Interviews Variables  Mean percentage & duration in days till RTW  Psychological complaints (BSI)  Other: i.e. Background (work & personal life), Self-efficacy, Coping, Working conditions  Guideline adherence Outcome measures  RTW (cox regression, logistic regression)  Full RTW y/n  Duration in days till full RTW  Psychological complaints (regression)

Method (2) Guideline indicators -> interview Examples guideline indicators: Did you talk about the working experience of the client? Did you know for how many hours or % the client was absent at the beginning of the treatment? Did you talk about factors in the workplace that obstruct RTW? Did you talk about factors in the workplace that reduce psychological complaints? Did you talk about factors outside of the workplace that stimulate RTW? Did you talk about the working conditions of the client? Do you know if a plan for RTW is made? Did you talk about how to prevent relapse?

Method (3) Psychologists:  Response N=131; included in analysis: N=90  74% female, mean age 45 (25-67), mean years of working as psychologist 11  Mixed sample (type of psychologists, type of company etc.)  Knowledge of guideline 2.5, use of guideline 2.2 (both 1-5)  Guideline adherence 25.3 (13-30) Employees:  Employees absent from work due to psychological complaints  Response N=196; included in analysis: N=98  55% female, mean age 44 (25-61), 81% stable relationship  Mixed sample (education level, type of job, company size etc.)  Sickness absence at baseline: mean 8 weeks (1-32)  Normal working hours, mean 33 (14-40)

Results (1) Psychological complaints Main effect of time RTW (% RTW irt contract) Main effect of time Duration full RTW: 154 days But what about guideline adherence? Mean baselineSDMean 6 mnthSDSig Mean baselineSDMean 6 mnthSDSig

Results (2) Analyses on 3 outcomes with overall score guideline adherence as covariate No differences found! Possible explanations: Too many indicators applied by everyone Too small variance of overall score Too small sample Look at single indicators of adherence: Univariately Multivariately

Results (3) A few indicators have an influence univariately, for instance: Did you talk about the work experience of the client? Did you talk about factors in the workplace that stimulate RTW? Did you talk about factors in the workplace that increase psychological complaints? Did you talk about labour relations of the client? Did you advise or carried out interventions where work related aspects were integrated? But multivariately effects diminish.

Results (4) Select extreme groups only: Score of (N=14) Score of (N=31) But no significant difference: B=.23, p=.58 Small sample Big variance within duration till full RTW Duration till full RTW: 179 days (83-336) 140 days (34-287)

Conclusion so far Some differences found, but no significant effects. Guideline is not specific enough  Too little variance  Some psychologists already implement work in their therapy  Small sample Majority of psychologists already implement the guideline in their usual treatment Improvement of guideline  More specific  Not only: do this, but also how to do this Results with all the data?