Roland W. B. Blonk

Reducing long term sickness absence by an activating intervention in adjustment disorders: a cluster randomised controlled design

Aims: To compare an innovative activating intervention with “care as usual” (control group) for the guidance of employees on sickness leave because of an adjustment disorder. It was hypothesised that the intervention would be more effective than care as usual in lowering the intensity of symptoms, increasing psychological resources, and decreasing sickness leave duration. Methods: A prospective, cluster randomised controlled trial was carried out with 192 patients on first sickness leave for an adjustment disorder. Symptom intensity, sickness duration, and return to work rates were measured at 3 months and 12 months. Analyses were performed on an intention to treat basis. Results: At 3 months, significantly more patients in the intervention group had returned to work compared with the control group. At 12 months all patients had returned to work, but sickness leave was shorter in the intervention group than in the control group. The recurrence rate was lower in the intervention group. There were no differences between the two study groups with regard to the decrease of symptoms. At baseline, symptom intensity was higher in the patients than in a normal reference population, but decreased over time in a similar manner in both groups to approximately normal levels. Conclusion: The experimental intervention for adjustment disorders was successful in shortening sick leave duration, mainly by decreasing long term absenteeism.

Stressful work, psychological job strain, and turnover: A 2-year prospective cohort study of truck drivers

Based on a model that combines existing organizational stress theory and job transition theory, this 2-year longitudinal study examined antecedents and consequences of turnover among Dutch truck drivers. For this purpose, self-reported data on stressful work (job demands and control), psychological strain (need for recovery after work and fatigue), and turnover were obtained from 820 drivers in 1998 and 2000. In agreement with the model, the results showed that strain mediates the influence of stressful work on voluntary turnover. Also in conformity with the model, job movement to any job outside the trucking industry (i.e., interoccupational turnover) resulted in a larger strain reduction as compared to job movement within the trucking industry (intraoccupational turnover). Finally, strain was found to stimulate interoccupational turnover more strongly than it stimulated intraoccupational turnover. These findings provide a thorough validation of existing turnover theory and give new insights into the turnover (decision) process.

Supervisory behaviour as a predictor of return to work in employees absent from work due to mental health problems

Aims: To study supervisory behaviour as a predictive factor for return to work of employees absent due to mental health problems; and to explore the association between conditional factors and supervisory behaviour. Methods: Eighty five supervisors of employees were interviewed by telephone. Questionnaires providing information on person related factors, depressive symptoms, and sickness absence were sent to the employees at baseline, three months, six months, and after one year. Three aspects of supervisory behaviour during the period of absence were measured: communication with the employee, promoting gradual return to work, and consulting of other professionals. Results: Better communication between supervisor and employee was associated with time to full return to work in non-depressed employees. For employees with a high level of depressive symptoms, this association could not be established. Consulting other professionals more often was associated with a longer duration of the sickness absence for both full and partial return to work. If sickness absence had financial consequences for the department, the supervisor was more likely to communicate frequently with the employee. Supervisors who were responsible for return to work in their organisation were more likely to communicate better and to consult more often with other professionals. Conclusion: Supervisors should communicate more frequently with employees during sickness absence as well as hold follow up meetings more often as this is associated with a faster return to work in those employees.

The Depression Anxiety Stress Scales (DASS): detecting anxiety disorder and depression in employees absent from work because of mental health problems

Aims: To (1) evaluate the psychometric properties and (2) examine the ability to detect cases with anxiety disorder and depression in a population of employees absent from work because of mental health problems. Methods: Internal consistency, construct validity, and criterion validity of the Depression Anxiety Stress Scales (DASS) were assessed. Furthermore, the ability to identify anxiety disorders or depression was evaluated by calculating posterior probabilities of these disorders following positive and negative test results for different cut off scores of the DASS-Depression and DASS-Anxiety subscales. Results: Internal consistency of the DASS subscales was high, with Cronbach’s alphas of 0.94, 0.88, and 0.93 for depression, anxiety, and stress respectively. Factor analysis revealed a three factor solution, which corresponded well with the three subscales of the DASS. Construct validity was further supported by moderately high correlations of the DASS with indices of convergent validity (0.65 and 0.75), and lower correlations of the DASS with indices of divergent validity (range −0.22 to 0.07). Support for criterion validity was provided by a statistically significant difference in DASS scores between two diagnostic groups. A cut off score of 5 for anxiety and 12 for depression is recommended. The DASS showed probabilities of anxiety and depression after a negative test result of 0.05 and 0.06 respectively. Probabilities of 0.29 for anxiety disorder and 0.33 for depression after a positive test result reflect relatively low specificity of the DASS. Conclusion: The psychometric properties of the DASS are suitable for use in an occupational health care setting. The DASS can be helpful in ruling out anxiety disorder and depression in employees with mental health problems.

Job stress, fatigue, and job dissatisfaction in Dutch lorry drivers: towards an occupation specific model of job demands and control

Objectives: Building on Karaseks model of job demands and control (JD-C model), this study examined the effects of job control, quantitative workload, and two occupation specific job demands (physical demands and supervisor demands) on fatigue and job dissatisfaction in Dutch lorry drivers. Methods: From 1181 lorry drivers (adjusted response 63%) self reported information was gathered by questionnaire on the independent variables (job control, quantitative workload, physical demands, and supervisor demands) and the dependent variables (fatigue and job dissatisfaction). Stepwise multiple regression analyses were performed to examine the main effects of job demands and job control and the interaction effect between job control and job demands on fatigue and job dissatisfaction. Results: The inclusion of physical and supervisor demands in the JD-C model explained a significant amount of variance in fatigue (3%) and job dissatisfaction (7%) over and above job control and quantitative workload. Moreover, in accordance with Karaseks interaction hypothesis, job control buffered the positive relation between quantitative workload and job dissatisfaction. Conclusions: Despite methodological limitations, the results suggest that the inclusion of (occupation) specific job control and job demand measures is a fruitful elaboration of the JD-C model. The occupation specific JD-C model gives occupational stress researchers better insight into the relation between the psychosocial work environment and wellbeing. Moreover, the occupation specific JD-C model may give practitioners more concrete and useful information about risk factors in the psychosocial work environment. Therefore, this model may provide points of departure for effective stress reducing interventions at work.

Behavioral assessment of avoidance in agoraphobia

Behavioral avoidance testing is a substantial addition to self-report questionnaires in the assessment of agoraphobia. However, the tests currently in use have drawbacks and limitations. A multitask behavioral avoidance test (M-BAT) is presented, designed to meet some of these problems. The test was administered to a group of 58 patients and proved to be reliable in terms of internal consistency. Concordance with self-report measures of agoraphobia indicated a high concurrent validity. In comparison with self-report questionnaires, the tests produced a slightly more conservative picture of gains achieved in treatment. Finally, the data revealed that the multitask test was more concordant with other measures of agoraphobia than a single-task test would have been.

Job stress and psychosomatic health complaints among Dutch truck drivers : A re-evaluation of Karasek's interactive job demand-control model

Karaseks Job Demand–Control Model (JD-C Model) assumes that decision latitude (control) moderates the impact of job demands on health and well-being. It was proposed that lack of evidence for this core ‘interaction hypothesis’ was a consequence of an inadequate conceptualization of decision latitude. Taking this proposition into consideration, we re-evaluated the JD-C Model using a sample of 517 Dutch truck drivers. Regression analyses revealed a significant job demands by job control interaction effect as well as significant main effects of the two independent variables on psychosomatic health complaints. However, the magnitude of the interaction effect was very small. Therefore, it was concluded that the interaction hypothesis was not supported in the present study. Copyright

The Parent-Child Interaction Questionnaire, PACHIQ

The development of the Parent–Child Interaction Questionnaire (PACHIQ) is described. The PACHIQ can be used to assess how a parent evaluates his or her relationship with each child in the family (PACHIQ-P), and vice versa (PACHIQ-Ch). The items refer to interpersonal behaviour and interpersonal feelings. Conceptually, the PACHIQ is based on learning theory and structural systems theory. For the Child version, a stable two-factor structure was found in three independent samples in the Netherlands. The common factors found in these analyses were interpreted as representing Authority and Acceptance. For the Parent version, a one-factor solution was found to be satisfactory. The reliabilities of the subscales and the total scale are good. Results obtained so far indicate that the validity is satisfactory.

Goal attainment scaling: An idiosyncratic method to assess treatment effectiveness in agoraphobia

Goal attainment scaling (GAS) is an individually tailored way to measure treatment gains, using a highly standardized procedure. An advantage of the method is that it takes into account individual characteristics of the patients, and at the same time the data are suitable for quantitative analysis and comparable across patients. Despite the wide acceptance and use of the method in the evaluation of psychotherapy, data on its psychometric properties are rather scarce. In the current study, GAS was used as one of several outcome measures in a research project on the effectiveness of various treatments for panic disorder with agoraphobia. Guidelines for GAS are presented as well as data on the reliability and validity of the procedure. Results indicate that the procedure is reliable, valid, and sensitive to the improvement of patients during treatment. Comparison of GAS with standardized measures revealed considerable concordance, although the clinical end status of patients diverged somewhat dependent on the measure considered.

Work characteristics and return to work in long-term sick-listed employees with depressive symptoms.

Purpose The present study investigated the relations between work characteristics, depressive symptoms and duration until full return to work (RTW) among long-term sick-listed employees. This knowledge may add to the development of effective interventions and prevention, especially since work characteristics can be subjected to interventions more easily than many disorder-related or personal factors. Methods this prospective cohort study with a two-year follow-up employs a sample of 883 Dutch employees who had been sick-listed for at least 13xa0weeks at baseline, who filled out three questionnaires: at 19xa0weeks, 1 and 2xa0years after the start of sick leave. The dependent measure was duration until full RTW. Results not working (partially) at baseline, low decision authority, high psychological demands, low supervisor support and low RTW self-efficacy were related to more depressive symptoms. The duration until full RTW was longer for employees with depressive symptoms. Low physical exertion, high RTW self-efficacy, working partially at baseline, being married or cohabiting, and young age were related to less time until full RTW. Other work characteristics appeared no independent predictors of RTW. Conclusions although the role of job demands and job resources in the RTW process is limited for long-term sick-listed employees with depressive symptoms, a few work characteristics are prognostic factors of full RTW. Focus on these elements in the selection or development of interventions may be helpful in preventing sickness absence, and in supporting long-term sick-listed employees towards full RTW.