Interventions for enhancing return to work in individuals with a common mental illness: systematic review and meta-analysis of randomized controlled trials

Abstract

Common mental disorders (CMDs) are highly prevalent in the working population, and are associated with long-term sickness absence and disability. Workers on sick leave with CMDs would benefit from interventions that enable them to successfully return to work (RTW). However, the effectiveness of RTW interventions for workers with a CMD is not well studied. The objective of this review is to assess the effectiveness of existing workplace and clinical interventions that were aimed at enhancing RTW. A systematic review of studies of interventions for improving RTW in workers with a CMD was conducted. The main outcomes were proportion of RTW and sick-leave duration until RTW. Randomized controlled trials (RCTs) were identified from Medline/PubMed, PsycINFO, EMBASE, SocINDEX, and Human resource and management databases from January 1995 to 2016. Two authors independently selected studies, assessed risk of bias and extracted data. We pooled studies that we deemed sufficiently homogeneous in different comparison groups and assessed the overall quality of the evidence. We reviewed 2347 abstracts from which 136 full-text articles were reviewed and 16 RCTs were included in the analysis. Combined results from these studies suggested that the available interventions did not lead to improved RTW rates over the control group [pooled risk ratio 1.05, 95% confidence interval (CI) 0.97-1.12], but reduced the number of sick-leave days in the intervention group compared to the control group, with a mean difference of -13.38 days (95% CI -24.07 to -2.69).

Systematic review and meta-analysis of interventions aimed at enhancing return to work for sick-listed workers with common mental disorders, stress-related disorders, somatoform disorders and personality disorders

“…Overall, the results revealed a significant, but relatively small, positive effect of the included interventions. The effect size is similar to the effect size reported by Nigatu et al 15 in their review of 16 studies testing CBT-interventions aimed at RTW for sick-listed workers with CMDs. However, other disease-specific reviews report diverging findings.…”

“…Only three of these reviews included a meta-analysis,13–15 and two of these were disorder-specific (ie, aimed at adjustment disorders13: or depression14). Nigatu and colleagues15 included a broader spectrum of mental disorders in their review and meta-analysis. The authors reviewed the literature on interventions aimed at enhancing RTW in sick-listed workers with common mental disorders, CMD (defined by the authors as depressive disorders, anxiety disorders and adjustment disorders).…”

Psychological treatments for return to work in individuals on sickness absence due to common mental disorders or musculoskeletal disorders: a systematic review and meta-analysis of randomized-controlled trials

“…This makes it difficult to draw firm conclusions about the significance of methodological quality for the outcome in this field in general. However, the methodological quality of a majority of included studies was low, which is not surprising given the risk of bias and methodological concerns discussed in previous meta-analyses in this field (Arends et al 2012; Nieuwenhuijsen et al 2014; Nigatu et al 2016). Hence, we conclude that low methodological quality is a problem to address before further evaluation of evidence for psychological treatment for RTW is carried out.…”

“…However, in this meta-analysis, the workplace interventions were merely one part of the interventions given and not a standalone intervention. In another meta-analysis, Nigatu et al (2016) noted that most trials included did not specifically address RTW, but rather aimed at symptomatic improvement. While we included more trials than van Vilsteren et al (2015) and Nigatu et al (2016) in the present meta-analysis, we reached the same conclusion.…”

“…The lack of effect for the two groups separately might indicate a power problem. In another meta-analysis of interventions for targeting enhanced RTW for individuals with a CMD, the authors reported a modest effect on the reduced number of SA days but concluded that the available interventions did not lead to improved RTW rates compared to the control group (Nigatu et al 2016). …”