1. Efficacy and cost-effectiveness of Acceptance and Commitment Therapy and a Workplace Intervention for workers on sickness absence due to mental disorders. Anna Finnes Psychologist, PhD student Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

2. 2015-08-24Anna Finnes2 Sickness absence due to mental disorders  Mental disorders are among the leading causes of disability  Especially among people in working ages  Most common diagnosis  Adjustment disorders  Depression  Long sickness absence spells

3. Treatment options?  Cognitive behavioral Therapy (CBT)  Not effective with regard to sickness absence/RTW  Acceptance and Commitment Therapy (ACT)  Third wave behavior therapy  Seeks the construction of broad, flexible behavior repertoires  Workplace interventions (WI)  Moderate quality evidence (Cochrane, 2009) for muskuloskeletal pain  No evidence for mental disorders  Combining clinical interventions with workplace interventions  Reduce both clinical symptoms and sickness absence? 2015-08-24Anna Finnes3

4. Efficacy of Acceptance and Commitment Therapy and a Workplace oriented intervention on RTW  The overall objective of the present study was to evaluate the efficacy of ACT and a WI, separately and in combination, in comparison to TAU.  RCT 2015-08-24Anna Finnes4

5. 2015-08-24Anna Finnes5 Study design Waiting-list control ABC program Recruitment ACT Treatment 3 months WI Post-measurement ACT+WITAU Assessment Randomization (n=352) Follow-up measurement (3 months) Follow-up measurement (9 months) Follow-up measurement (21 months) Pre-measurement

6. Acceptance and Commitment Therapy ACT  6 sessions (60 min)  Treatment manual  Case conceptualization  Acceptance and mindfulness skills training  Clarification of personal values and life goals  Behaviour activation  Between sessions tasks  Reading material  Exercises 2015-08-24Anna Finnes6

7. Workplace Dialogue Intervention (Karlsson et al, 2010) Causes at work and outside work? What has been done? Own suggestions? Employers efforts? 1.Interview client 2. Interview supervisor Summary Solutions Suggested changes Initiate dialogue 3. Convergence dialogue meeting 7

8. Results Descriptive data (n=352) Mean age: 47.6 (SD=8.84) Range 26-60 78.5 % women 60% finished university degree Compensated sickness absence days past 24 months: m=126.7 (SD=97.4)  Diagnostic groups: 8

9. Net Sickness absence days  PRE - POST  No overall difference between groups over time F(3,1720)=1.272, p=.282)  All groups improved over time F(1,1720)=43.285, p<.001)  No differences between groups F(3,1720)=.273, p=.845)  Follow-up  No interaction effect  All groups improved over time  No differences between groups  None of the intervention groups outperformed TAU 2015-08-24Anna Finnes9

10. Symptoms  PRE to POST  Symptoms of exhaustion (KEDS) (p=.03)  ACT (b = -3.51, p=.003, d=.49)  ACT+WDI (b = -2.38, p=.049, d=.33)  Symptoms of depression (HADS dep) (p =.017)  ACT (b = -1.98, p=.002, d=.55)  ACT+WDI (b = -1.28, p=.045, d=.36  Symptoms of anxiety (HADS anx) (p=.082)  ACT (b = -1.98, p=.019, d=.39)  No differences between groups over time during follow-up 2015-08-24Anna Finnes10

11. Economic evaluation Limited societal perspective 2015-08-24Anna Finnes11  Cost-utility analysis  Costs  Effect: QALY EuroQol 5D (EQ-5D)  ICER: the price for one life year in full health gained Costs ACT (n=62)WDI (n=45)ACT+WDI (n=61)TAU (n=62) Intervention 305368670 0 Health care 5 2135 5655 0575 995 Social security8 5028 72810 3488 924 Sum:14 02014 66116 07514 919

12. Economic evaluation Limited societal perspective  Cost-utility analysis 2015-08-24Anna Finnes12 Alt. GroupNQALYCostInc. costInc. effectICER A 00 B ACT690,688714 020 0,688720 357 F ACT+WDI630,713416 0742 0550,024783 183 ACT

13. 2015-08-24Anna Finnes13 Thank you for your attention!

14. Work ability (Work Ability Index)  No significant differences between groups over time  All groups improved over time  None of the intervention groups outperformed TAU 2015-08-24Anna Finnes14

15. Economic evaluation Health care perspective  Cost-utility analysis: cost per QALY 2015-08-24Anna Finnes15 Alt. GroupNQALYCostInc. costInc. effectICER A 00 B ACT690,6895 518 0,68878 012 C ACT+WDI630,7135 7272090,02478 464 D WDI450,6725 933206-0,0414-4 973 E TAU650,6675 99562-0,0055-11 265 ACT ACT+WDI TAU WDI