A cluster-randomised trial evaluating an intervention for patients with stress-related mental disorders and sick leave in primary care

Ingrid M Bakker, Berend Terluin, Harm W J van Marwijk, Daniëlle A W M van der Windt, Frank Rijmen, Willem van Mechelen, Wim A B Stalman

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVE: Mental health problems often affect functioning to such an extent that they result in sick leave. The worldwide reported prevalence of mental health problems in the working population is 10%-18%. In developed countries, mental health problems are one of the main grounds for receiving disability benefits. In up to 90% of cases the cause is stress-related, and health-care utilisation is mainly restricted to primary care. The aim of this study was to assess the effectiveness of our Minimal Intervention for Stress-related mental disorders with Sick leave (MISS) in primary care, which is intended to reduce sick leave and prevent chronicity of symptoms.

DESIGN: Cluster-randomised controlled educational trial.

SETTING: Primary health-care practices in the Amsterdam area, The Netherlands.

PARTICIPANTS: A total of 433 patients (MISS n = 227, usual care [UC] n = 206) with sick leave and self-reported elevated level of distress.

INTERVENTIONS: Forty-six primary care physicians were randomised to either receive training in the MISS or to provide UC. Eligible patients were screened by mail.

OUTCOME MEASURES: The primary outcome measure was duration of sick leave until lasting full return to work. The secondary outcomes were levels of self-reported distress, depression, anxiety, and somatisation.

RESULTS: No superior effect of the MISS was found on duration of sick leave (hazard ratio 1.06, 95% confidence interval 0.87-1.29) nor on severity of self-reported symptoms.

CONCLUSIONS: We found no evidence that the MISS is more effective than UC in our study sample of distressed patients. Continuing research should focus on the potential beneficial effects of the MISS; we need to investigate which elements of the intervention might be useful and which elements should be adjusted to make the MISS effective.

Original languageEnglish
Pages (from-to)e26
JournalPLoS clinical trials
Volume2
Issue number6
DOIs
Publication statusPublished - 1 Jun 2007

Cite this

Bakker, Ingrid M ; Terluin, Berend ; van Marwijk, Harm W J ; van der Windt, Daniëlle A W M ; Rijmen, Frank ; van Mechelen, Willem ; Stalman, Wim A B. / A cluster-randomised trial evaluating an intervention for patients with stress-related mental disorders and sick leave in primary care. In: PLoS clinical trials. 2007 ; Vol. 2, No. 6. pp. e26.
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title = "A cluster-randomised trial evaluating an intervention for patients with stress-related mental disorders and sick leave in primary care",
abstract = "OBJECTIVE: Mental health problems often affect functioning to such an extent that they result in sick leave. The worldwide reported prevalence of mental health problems in the working population is 10{\%}-18{\%}. In developed countries, mental health problems are one of the main grounds for receiving disability benefits. In up to 90{\%} of cases the cause is stress-related, and health-care utilisation is mainly restricted to primary care. The aim of this study was to assess the effectiveness of our Minimal Intervention for Stress-related mental disorders with Sick leave (MISS) in primary care, which is intended to reduce sick leave and prevent chronicity of symptoms.DESIGN: Cluster-randomised controlled educational trial.SETTING: Primary health-care practices in the Amsterdam area, The Netherlands.PARTICIPANTS: A total of 433 patients (MISS n = 227, usual care [UC] n = 206) with sick leave and self-reported elevated level of distress.INTERVENTIONS: Forty-six primary care physicians were randomised to either receive training in the MISS or to provide UC. Eligible patients were screened by mail.OUTCOME MEASURES: The primary outcome measure was duration of sick leave until lasting full return to work. The secondary outcomes were levels of self-reported distress, depression, anxiety, and somatisation.RESULTS: No superior effect of the MISS was found on duration of sick leave (hazard ratio 1.06, 95{\%} confidence interval 0.87-1.29) nor on severity of self-reported symptoms.CONCLUSIONS: We found no evidence that the MISS is more effective than UC in our study sample of distressed patients. Continuing research should focus on the potential beneficial effects of the MISS; we need to investigate which elements of the intervention might be useful and which elements should be adjusted to make the MISS effective.",
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A cluster-randomised trial evaluating an intervention for patients with stress-related mental disorders and sick leave in primary care. / Bakker, Ingrid M; Terluin, Berend; van Marwijk, Harm W J; van der Windt, Daniëlle A W M; Rijmen, Frank; van Mechelen, Willem; Stalman, Wim A B.

In: PLoS clinical trials, Vol. 2, No. 6, 01.06.2007, p. e26.

Research output: Contribution to journalArticleAcademicpeer-review

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AU - Bakker, Ingrid M

AU - Terluin, Berend

AU - van Marwijk, Harm W J

AU - van der Windt, Daniëlle A W M

AU - Rijmen, Frank

AU - van Mechelen, Willem

AU - Stalman, Wim A B

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N2 - OBJECTIVE: Mental health problems often affect functioning to such an extent that they result in sick leave. The worldwide reported prevalence of mental health problems in the working population is 10%-18%. In developed countries, mental health problems are one of the main grounds for receiving disability benefits. In up to 90% of cases the cause is stress-related, and health-care utilisation is mainly restricted to primary care. The aim of this study was to assess the effectiveness of our Minimal Intervention for Stress-related mental disorders with Sick leave (MISS) in primary care, which is intended to reduce sick leave and prevent chronicity of symptoms.DESIGN: Cluster-randomised controlled educational trial.SETTING: Primary health-care practices in the Amsterdam area, The Netherlands.PARTICIPANTS: A total of 433 patients (MISS n = 227, usual care [UC] n = 206) with sick leave and self-reported elevated level of distress.INTERVENTIONS: Forty-six primary care physicians were randomised to either receive training in the MISS or to provide UC. Eligible patients were screened by mail.OUTCOME MEASURES: The primary outcome measure was duration of sick leave until lasting full return to work. The secondary outcomes were levels of self-reported distress, depression, anxiety, and somatisation.RESULTS: No superior effect of the MISS was found on duration of sick leave (hazard ratio 1.06, 95% confidence interval 0.87-1.29) nor on severity of self-reported symptoms.CONCLUSIONS: We found no evidence that the MISS is more effective than UC in our study sample of distressed patients. Continuing research should focus on the potential beneficial effects of the MISS; we need to investigate which elements of the intervention might be useful and which elements should be adjusted to make the MISS effective.

AB - OBJECTIVE: Mental health problems often affect functioning to such an extent that they result in sick leave. The worldwide reported prevalence of mental health problems in the working population is 10%-18%. In developed countries, mental health problems are one of the main grounds for receiving disability benefits. In up to 90% of cases the cause is stress-related, and health-care utilisation is mainly restricted to primary care. The aim of this study was to assess the effectiveness of our Minimal Intervention for Stress-related mental disorders with Sick leave (MISS) in primary care, which is intended to reduce sick leave and prevent chronicity of symptoms.DESIGN: Cluster-randomised controlled educational trial.SETTING: Primary health-care practices in the Amsterdam area, The Netherlands.PARTICIPANTS: A total of 433 patients (MISS n = 227, usual care [UC] n = 206) with sick leave and self-reported elevated level of distress.INTERVENTIONS: Forty-six primary care physicians were randomised to either receive training in the MISS or to provide UC. Eligible patients were screened by mail.OUTCOME MEASURES: The primary outcome measure was duration of sick leave until lasting full return to work. The secondary outcomes were levels of self-reported distress, depression, anxiety, and somatisation.RESULTS: No superior effect of the MISS was found on duration of sick leave (hazard ratio 1.06, 95% confidence interval 0.87-1.29) nor on severity of self-reported symptoms.CONCLUSIONS: We found no evidence that the MISS is more effective than UC in our study sample of distressed patients. Continuing research should focus on the potential beneficial effects of the MISS; we need to investigate which elements of the intervention might be useful and which elements should be adjusted to make the MISS effective.

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SN - 1555-5887

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