Employment effects of a multidisciplinary health assessment for mentally ill persons - A quasi-randomised controlled trial.

AIM: Relatively little is known about the effectiveness of return-to-work interventions for employees sick-listed with mental disorders, and the results of the literature are contradictory. This study evaluated the return-to-work effect of a multidisciplinary health assessment for persons sick-listed with mental disorders. METHODS: The study population consisted of 244 persons who were allocated to the treatment and control groups based on their birth year. In addition to the usual case management, the treatment group ( n = 83) was assessed by a team consisting of a case manager, a psychiatrist, and a job coach. The control group ( n = 99) received the usual case management. We used unique register data to code outcome variables (sick-leave duration and return-to-work duration). RESULTS: The multidisciplinary treatment had no statistically significant effect on the sick-leave duration (HR = 1.05; 95% CI 0.74-1.43) or the return-to-work duration (HR = 0.94; 95% CI 0.65-1.35). Subgroup analyses showed that the treatment effect did not systematically depend on age, education or severity of the mental disorder. We found no signs of systematic dropout from the study population or of imbalanced data. We found an insignificant tendency indicating that control-group case managers may have learned about the intervention from treatment case managers ( p = 0.31). CONCLUSIONS: This study showed no return-to-work effect of a multidisciplinary assessment of sick-listed individuals with mental disorders. Together with the sparse and inconclusive findings of the literature, this finding suggests that further research is needed for disentangling the elements that constitute an effective intervention.

Improving the effectiveness of sickness benefit case management through a public-private partnership? A difference-in-difference analysis in eighteen Danish municipalities.

BACKGROUND: The aim of this study was to investigate whether a multidimensional public-private partnership intervention, focussing on improving the quality and efficiency of sickness benefit case management, reduced the sickness benefit duration and the duration until self-support. METHODS: We used a difference-in-difference (DID) design with six intervention municipalities and 12 matched control municipalities in Denmark. The study sample comprised 282,103 sickness benefit spells exceeding four weeks. The intervention group with 110,291 spells received the intervention, and the control group with 171,812 spells received ordinary sickness benefit case management. Using register data, we fitted Cox proportional hazard ratio models, estimating hazard ratios (HR) and confidence intervals (CI). RESULTS: We found no joint effect of the intervention on the sickness benefit duration (HR 1.02, CI 0.97-1.07) or the duration until self-support (HR 0.99, CI 0.96-1.02). The effect varied among the six municipalities, with sickness benefit HRs ranging from 0.96 (CI 0.93-1.00) to 1.13 (CI 1.08-1.18) and self-support HRs ranging from 0.91 (CI 0.82-1.00) to 1.11 (CI 1.06-1.17). CONCLUSIONS: Compared to receiving ordinary sickness benefit management the intervention had on average no effect on the sickness benefit duration or duration until self-support. However, the effect varied considerably among the six municipalities possibly due to differences in the implementation or the complexity of the intervention.

The effect of part-time sick leave for employees with mental disorders.

BACKGROUND: Part-time sick leave (PTSL) allows employees on full-time sick leave (FTSL) to resume work at reduced hours. When the partly absent employee's health improves, working hours are increased until the employee is able to work regular hours. Studies have found that PTSL is an effective instrument for reducing sick leave durations for employees with musculoskeletal disorders and for employees on sick leave in general. This is the first published article to document how PTSL affects sick leave durations for employees with mental disorders. AIM: The aim is to estimate the effect of PTSL on the duration until returning to regular working hours for employees with mental disorders. We compare this effect to that of PTSL for employees with non-mental disorders ('other disorders'). METHODS: We use combined survey and register data about 226 employees on long-term sick leave with mental disorders and 638 employees with other disorders. These data contain information about type of disorder, PTSL and FTSL (full-time sick leave) durations, and various background characteristics. We use a mixed proportional hazard regression model that allows us to control for unobserved differences between employees on PTSL and those on FTSL. RESULTS: Our analyses show that PTSL has no effect on the duration until returning to regular working hours for employees with mental disorders. Furthermore, looking at specific disorders such as depression and stress-related conditions, we find no significant effects of PTSL. In contrast, in line with previous research, we find that PTSL significantly reduces the duration until returning to regular working hours for employees with other disorders. The analyses also illustrate the importance of controlling for unobserved differences between employees on PTSL and those on FTSL. Without this control, PTSL significantly reduces the duration until returning to regular working hours. When we control for unobserved characteristics, this effect decreases, and for employees with mental disorders the effect vanishes entirely. DISCUSSION AND LIMITATIONS: The lack of an effect of PTSL for employees with mental disorders needs replication in other studies. If subsequent studies confirm our findings, one should not necessarily conclude that PTSL is an ineffective intervention: PTSL may play a role in combination with other workplace interventions and in combination with person-centred interventions. The study is limited by self-reported data about disorders and a relatively small number of employees with mental disorders. CONCLUSION AND IMPLICATIONS: Our findings suggest that while PTSL reduces sick leave durations for employees with other disorders, it does not affect sick leave durations for employees with mental disorders. These results may indicate that PTSL by itself is insufficient for promoting the return to work of employees with mental disorders. FUTURE RESEARCH: Future studies could benefit from larger data sets with disorder information based on medical assessments. In addition to quantitative effect studies, future studies could focus on qualitative workplace mechanisms that may counteract the potential positive effects of PTSL for employees on sick leave with mental disorders.

Employment effects of active labor market programs for sick-listed workers.

We use register data of 88,948 sick-listed workers in Denmark over the period 2008-2011 to investigate the effect of active labor market programs on the duration until returning to non-subsidized employment and the duration of this employment. To identify causal treatment effects, we exploit over-time variation in the use of active labor market programs in 98 job centers and time-to- event. We find that ordinary education and subsidized job training have significant positive employment effects. Subsidized job training has a large, positive effect on the transition into employment but no effect on the subsequent employment duration. In contrast, ordinary education has a positive effect on employment duration but no effect on the transition into employment. The latter effect is the result of two opposing effects, a large positive effect of having completed education and a large negative lock-in effect, with low re-employment chances during program participation.

Case management interviews and the return to work of disabled employees.

This study measures the effect of case management interview (CMI) on 1,000 long-term sick-listed employees' probability of returning to work. In contrast to previous studies, we use instrumental variables to correct for selection effects in CMI. Using a competing hazard rate model, we find that CMI increases the probability of returning to work for the pre-sick leave employer, but has no effect on the probability of resuming work for a new employer. We argue that CMI either motivates the sick-listed employees to resume work or adjusts for asymmetric information between the employee and the pre-sick leave employer.

Reintegration: public or private responsibility? Consequences of Dutch and Danish policies toward work-disabled persons.

The Scandinavian welfare states are known for their universal social security coverage and high labor-market participation rates for all groups in society. The institutional setup in continental European welfare states, on the other hand, is said to foster a divide between employed persons and persons outside the labor market. In the area of disability policies, The Netherlands and Denmark illustrate this distinction. In The Netherlands, strong ties exist between the employer and the sick-listed worker, both because of solid job-protection legislation and because the financing of sickness and disability benefits is closely linked to the individual employer. In contrast, employer responsibility is limited in Denmark, where an extensive responsibility rests with public authorities. The author investigates the consequences of these differences using panel data on Dutch and Danish long-term sick-listed workers. The findings show that the strong ties in The Netherlands between employers and sick-listed workers enhance labor-market reintegration of long-term sick-listed workers. A significant drawback of the Dutch policy, however, is that employers refrain from employing persons with a high risk of falling ill. As a result, Dutch disability policy leads to a bigger insider-outsider divide than Danish policy.

Does graded return-to-work improve sick-listed workers' chance of returning to regular working hours?

Using Danish register and survey data, we examine the effect of a national graded return-to-work program on the probability of sick-listed workers returning to regular working hours. During program participation, the sick-listed worker works fewer hours and receives the normal hourly wage for the hours worked and sickness benefit for the hours off work. When the worker's health improves, working hours are increased until the sick-listed worker is able to work regular hours. Taking account of unobserved differences between program participants and non-participants, we find that participation in the program significantly increases the probability of returning to regular working hours.