Suzanne E. Lagerveld

Return to work: A comparison of two cognitive behavioural interventions in cases of work-related psychological complaints among the self-employed

Abstract We investigated the effectiveness of cognitive behavioural therapy (CBT) and a combined intervention of workplace- and individual-focused techniques among self-employed people on sick leave owing to work-related psychological complaints (such as anxiety, depression, and burnout). Both interventions were based on CBT; however, one was conducted by psychotherapists and involved extensive CBT, while the other was delivered by “labour experts” and consisted of a brief CBT-derived intervention combined with both individual-focused and workplace interventions. One hundred and twenty-two self-employed people who had applied for sickness benefit from an insurance company enrolled in a randomized controlled design. These individuals were assessed before the intervention and then at 4 months and 10 months after the onset of the intervention. The outcome was assessed based on duration of sick leave until partial and full return to work and on psychological complaints. Significant effects on partial and full return were found in favour of the combined intervention: partial return occurred 17 and 30 days earlier in this group than in the CBT group and the control group, respectively. For full return to work, the difference was approximately 200 days. A decrease in psychological complaints was present in each condition but we found no significant interaction effects. The results suggest that work resumption should be addressed earlier in individuals receiving CBT. This insight is of value for the (scarce) literature concerning interventions for individuals who are on sick leave owing to work-related psychological complaints.

Work-Focused Treatment of Common Mental Disorders and Return to Work: A Comparative Outcome Study

The aim of this study was to compare the effectiveness of two individual-level psychotherapy interventions: (a) treatment as usual consisting of cognitive-behavioral therapy (CBT) and (b) work-focused CBT (W-CBT) that integrated work aspects early into the treatment. Both interventions were carried out by psychotherapists with employees on sick leave because of common mental disorders (depression, anxiety, or adjustment disorder). In a quasi-experimental design, 12-month follow-up data of 168 employees were collected. The CBT group consisted of 79 clients, the W-CBT group of 89. Outcome measures were duration until return to work (RTW), mental health problems, and costs to the employer. We found significant effects on duration until RTW in favor of the W-CBT group: full RTW occurred 65 days earlier. Partial RTW occurred 12 days earlier. A significant decrease in mental health problems was equally present in both conditions. The average financial advantage for the employer of an employee in the W-CBT group was estimated at

Return to work among employees with mental health problems: Development and validation of a self-efficacy questionnaire

5,275 U.S. dollars compared with the CBT group. These results show that through focusing more and earlier on work-related aspects and RTW, functional recovery in work can be substantially speeded up within a regular psychotherapeutic setting. This result was achieved without negative side effects on psychological complaints over the course of 1 year. Integrating work-related aspects into CBT is, therefore, a fruitful approach with benefits for employees and employers alike.

All day and all of the night: The relative contribution of two dimensions of workaholism to well-being in self-employed workers

Abstract Because of the costs to both the organization and the individual, it is important that employees who are sick-listed with mental health problems are facilitated in their return to work (RTW). In order to provide adequate interventions, it is necessary to obtain a better understanding of the RTW process of people with mental health problems. Work-related self-efficacy (SE) might play a key role within this process. This paper describes the development and validation of the return-to-work self-efficacy’ scale (RTW-SE) for employees with mental health problems. Three Dutch samples of sick-listed employees were used to validate the 11-item instrument (N=2214). Based on the factor structure and reliability results, RTW-SE was conceptualized as a unitary construct. The associations with general SE, locus of control, coping, physical workload and mental health problems support the construct validity of this scale. Most importantly, RTW-SE proved to be a robust predictor of actual return to work within three months. The encouraging preliminary psychometric properties of the scale make it a potentially valuable tool in research and in clinical practice and occupational health care settings, both before and after employees have returned to work.

Predictive value of work-related self-efficacy change on RTW for employees with common mental disorders

Abstract This study examined the associations between workaholism and perceived health (exhaustion, physical complaints, and feelings of professional efficacy) in a sample of 477 Dutch self-employed workers. We defined workaholism as having two components: (1) spending many hours on ones work, and (2) the inability to detach from work. We expected that both workaholism components would be related to ill health. ANOVA and regression analyses revealed that this reasoning was confirmed for one component (inability to detach from work), whereas the other component (working long hours) was unrelated to the outcome variables. In order to increase understanding of these findings, we suggest that more theoretical work be conducted on the mechanisms linking workaholism to its presumed antecedents and consequences.

Moeilijk objectiveerbare klachten in de praktijk van de bedrijfs- en verzekeringsarts : een empirisch onderzoek

To improve interventions that aim to promote return to work (RTW) of workers with common mental disorders (CMD), insight into modifiable predictors of RTW is needed. This study tested the predictive value of self-efficacy change for RTW in addition to preintervention levels of self-efficacy. RTW self-efficacy was measured 5 times within 9 months among 168 clients of a mental healthcare organisation who were on sick leave due to CMD. Self-efficacy parameters were modelled with multilevel analyses and added as predictors into a Cox regression analysis. Results showed that both high baseline self-efficacy and self-efficacy increase until full RTW were predictive of a shorter duration until full RTW. Both self-efficacy parameters remained significant predictors of RTW when controlled for several relevant covariates and within subgroups of employees with either high or low preintervention self-efficacy levels. This is the first study that demonstrated the prognostic value of self-efficacy change, over and above the influence of psychological symptoms, for RTW among employees with CMD. By showing that RTW self-efficacy increase predicted a shorter duration until full RTW, this study points to the relevance of enhancing RTW self-efficacy in occupational or mental health interventions for employees with CMD. Efforts to improve self-efficacy appear valuable both for people with relatively low and high baseline self-efficacy.

Predicting the Effectiveness of Work-Focused CBT for Common Mental Disorders: The Influence of Baseline Self-Efficacy, Depression and Anxiety

SamenvattingDit artikel beschrijft de belangrijkste uitkomsten van een empirisch onderzoek naar de problematiek van ‘moeilijk objectiveerbare gezondheidsklachten’ in de bedrijfs- en verzekeringsgeneeskundige praktijk. Een belangrijk doel van dit onderzoek was de aard en omvang van deze problematiek in kaart te brengen. Hiervoor werd een vragenlijstonderzoek verricht onder 18 bedrijfs- en 19 verzekeringsartsen, waarbij ruim 1200 korte casussen zijn beschreven. De uitkomsten duiden erop dat de problematiek van moeilijk objectiveerbare klachten in de bedrijfs- en verzekeringsgeneeskundige praktijk aanzienlijk is. Het gaat hierbij met name om pijn-, energetische en affectieve klachten. Moeilijk objectiveerbare gezondheidsklachten blijken voorts gepaard te gaan met problemen met betrekking tot het vaststellen van de gepaste begeleiding en het beoordelen van beperkingen en arbeidsmogelijkheden. Verder blijkt dat een relatief groot deel van de artsen behoefte heeft aan aanvullende instrumenten, kennis en vaardigheden met betrekking tot moeilijk objectiveerbare gezondheidsklachten. De auteurs pleiten voor aanvullend beleid of de ontwikkeling van een protocol/checklist, om de problematiek van moeilijk objectiveerbare gezondheidsklachten te verminderen.

Factors Associated with Work Participation and Work Functioning in Depressed Workers: A Systematic Review

Purpose This study examined who benefits most from a cognitive behavioural therapy (CBT)-based intervention that aims to enhance return to work (RTW) among employees who are absent due to common mental disorders (CMDs) (e.g., depression, anxiety, or adjustment disorder). We researched the influence of baseline work-related self-efficacy and mental health (depressive complaints and anxiety) on treatment outcomes of two psychotherapeutic interventions. Methods Using a quasi-experimental design, 12-month follow-up data of 168 employees were collected. Participants either received work-focused cognitive behavioural therapy (W-CBT) that integrated work aspects early into the treatment (n = 89) or regular cognitive behavioural therapy (R-CBT) without a focus on work (n = 79). Results Compared with R-CBT, W-CBT resulted in a faster partial RTW, irrespective of baseline self-efficacy. Among individuals with high self-efficacy, W-CBT also resulted in faster full RTW. The effectiveness of W-CBT on RTW did not depend on baseline depressive complaints or anxiety. The decline of mental health complaints did not differ between the two interventions, nor depended on baseline self-efficacy or mental health. Conclusions Considering the benefits of W-CBT for partial RTW, we recommend this intervention as a preferred method for employees with CMDs, irrespective of baseline self-efficacy, depression and anxiety. For individuals with high baseline self-efficacy, this intervention also results in higher full RTW. For those with low self-efficacy, extra exercises or components may be needed to promote full RTW.