Prevention of long-term sickness absence and major depression in high-risk employees: a randomised controlled trial.

OBJECTIVES: To examine the efficacy of early intervention on the prevention of long-term sickness absence and major depression among employees at high risk of future sickness absence and with mild to severe depressive complaints. METHODS: Randomised controlled trial conducted among employees working in an office environment. 139 employees were identified both at high risk of future sickness absence and with mild to severe depressive complaints through screening. Subsequently, they were randomly assigned to the intervention group (n = 69) or the control group (n = 70). Objective sickness absence was analysed at 12 and 18 months of follow-up. Depressive complaints were assessed by the Beck Depression Inventory (BDI-II) at baseline, and at 6 and 12 months of follow-up. RESULTS: Intention-to-treat analyses showed a significant difference in total sickness absence duration between the intervention (27.5 calendar days (SD 44.7)) and control group (50.8 days (SD 75.8)) over 12 months of follow-up, a reduction of 46% (p = 0.017). The intervention group showed a non-significantly lower proportion of long-term sickness absence spells compared with the control group (p = 0.127). Statistically significant and clinically relevant differences in depressive complaints were found after both 6 months (p = 0.001) and 12 months (p = 0.005) of follow-up, in favour of the intervention group. Relative risk reductions (RRR) were 19.2% and 19.8% respectively. Sickness absence data were available for all participants over 18 months of follow-up. Questionnaire data were available for 99 (at 6 months) and 90 participants (at 12 months). No adverse events or side effects occurred. CONCLUSIONS: Early intervention in employees with mild to severe depressive complaints and high risk of future long-term sickness absence proved to be effective in preventing/reducing both sickness absence and depressive complaints.

Screening questionnaire Balansmeter proved successful in predicting future long-term sickness absence in office workers.

OBJECTIVE: To develop and validate a screening instrument to identify employees at high risk for future long-term sickness absence. STUDY DESIGN AND SETTING: The instrument was developed (n=5,601) and internally validated (n=3,383) through data analyses of the Maastricht Cohort Study, among a group of office workers not absent from work. External validation was performed in a cohort of 3,895 bank employees. RESULTS: The screening instrument, Balansmeter, captures 34 questions on demographics, work environment, private situation, (mental) health, and sickness absence history. The Balansmeter showed good predictive values for future sickness absence (>28 days) in men (internal validation relative risk [RR] 4.69 [95% confidence interval (CI): 2.74, 8.02]; external validation RR 3.90 [95% CI: 2.35, 6.45]) and women (internal validation RR 4.16 [95% CI: 2.05, 8.43]; external validation RR 2.62 [95% CI: 1.44, 4.77]). CONCLUSION: It is possible to predict future sickness absence. The Balansmeter can be considered a valuable screening instrument.

Structured early consultation with the occupational physician reduces sickness absence among office workers at high risk for long-term sickness absence: a randomized controlled trial.

OBJECTIVE: To examine the efficacy of structured early consultation among employees at high risk for future long-term sickness absence, in the prevention and/or reduction of sickness absence. The focus of the experiment was the timing of the intervention, that is, treatment before sickness absence actually occurs. METHODS: In the current prospective randomized controlled trial (RCT), employees at high risk for long-term sickness absence were selected based on responses to a 34-item screening questionnaire including demographic, workplace, health and psychosocial factors associated with long-term sickness absence (>28 days). A total of 299 subjects at risk for future long-term sickness absence were randomized in an experimental group (n = 147) or in a control group (n = 152). Subjects in the experimental group received a structured early consult with their occupational physician (OP), in some cases followed by targeted intervention. The control group received care as usual. Sickness absence was assessed objectively through record linkage with the company registers on sickness absence over a 1 year follow-up period. RESULTS: Modified intention-to-treat analysis revealed substantial and statistically significant differences (p = 0.007) in total sickness absence duration over 1 year follow-up between the experimental (mean 18.98; SD 29.50) and control group (mean 31.13; SD 55.47). Per-protocol analysis additionally showed that the proportion of long-term sickness absence spells (>28 days) over 1 year follow-up was significantly (p = 0.048) lower in the experimental (9.1%) versus control group (18.3%). CONCLUSIONS: Structured early consultation with the OP among employees at high risk for future long-term sickness absence is successful in reducing total sickness absence.