Young adults' work-family life courses and mental health trajectories from adolescence to young adulthood: a TRAILS study.

PURPOSE: Work-family life courses have been associated with mental health at various time points in life but little is known about how mental health develops during these work-family life courses. The aim of this study was to examine mental health trajectories from adolescence to young adulthood in women and men with different work-family life courses. METHODS: Data from 992 young adults participating in the 18-year follow-up TRacking Adolescents' Individual Lives Survey (TRAILS) were used. Work-family life courses from ages 18 to 28 years were previously constructed using sequence analysis. For each work-family life course, trajectories of internalising and externalising problems from ages 11 to 29 years were estimated using a multi-group random intercept growth model. Differences in mental health trajectories were examined across work-family life courses. RESULTS: For women, trajectories of internalising and externalising problems in young adulthood differed significantly between work-family life courses (p = 0.037 and p < 0.001, respectively). Women in the inactive work-family life course reported the highest scores of internalising and externalising problems during the entire young adulthood but the differences in mental health scores became most pronounced at age 29. Trajectories of internalising and externalising problems of men did not significantly differ between the work-family life courses. CONCLUSION: Mental health trajectories differed between women depending on their work-family life course. In men, differences between work-family life courses were less pronounced. Future studies should examine which work-family events and transitions captured in work-family life courses are associated with subsequent mental health problems during longer follow-up.

Direct and indirect associations between childhood adversity and emotional and behavioral problems at age 14: A network analytical approach.

We applied network analysis combined with community detection algorithms to examine how adverse experiences (AEs) (e.g., abuse, bullying victimization, financial difficulties) are, individually and conjunctively, associated with emotional and behavioral problems at age fourteen in the Dutch TRacking Adolescents' Individual Lives Survey (TRAILS, N = 1880, 52.2% female). We found that bullying victimization, peer rejection, parental mental health problems, emotional abuse, and sexual abuse were the only AEs directly contributing to risk of emotional problems. Parental divorce and emotional abuse were the only AEs directly contributing to risk of behavioral problems. Most AEs (e.g., parental employment, parental physical illness) were not conditionally associated with emotional and behavioral problems but may nevertheless contribute to emotional and behavioral problems via associations with other AEs (e.g., parental unemployment and emotional abuse). Community detection algorithms suggested that many of the AEs cluster together (e.g., physical abuse, emotional abuse, and sexual abuse; financial difficulties and parental unemployment), sometimes with emotional and behavioral problems (e.g., bullying victimization, peer rejection and emotional problems). Our findings shed light on how individual AEs contribute to risks of emotional and behavioral problems directly, and indirectly through associations with other AEs.

Associations between type of childhood adversities and labour market participation and employment conditions in young adults.

BACKGROUND: Cumulative exposure to childhood adversity is associated with a variety of labour market outcomes in young adulthood. It remains largely unclear whether the type of adversity matters in this association. This prospective study examined the differences in exposure to 14 adverse experiences among groups of young adults aged 22 characterised by distinct labour market participation states and employment conditions. METHODS: We used data from the TRacking Adolescents' Individual Lives Survey, a Dutch prospective cohort study with 15 years of follow-up (N=1524). We included 14 adverse experiences (ages 0-16) across five domains: peer influences, loss or threat of loss, material deprivation, family dynamics and maltreatment. Labour market participation states and employment conditions were assessed at age 22. We used latent class analysis to derive labour market outcome groups, which we subsequently compared on exposure to adverse experiences using pairwise comparisons. RESULTS: Inactive individuals (n=85, 5.6%), often neither in education (77.4%) nor employment (98.6%) and on benefits (94.4%), were more likely to be exposed to many distinct types of adverse experiences (eg, parental addiction, bullying victimisation) as compared with all other groups. Early workers (n=413, 27.1%), often on temporary contracts and low monthly incomes, were more likely to be exposed to parental divorce (22.7%) compared with students with side jobs (12.9%). CONCLUSIONS: Different adverse experiences are not equally associated with labour market outcomes. Researchers and stakeholders in policy and practice should be aware of the differences between adverse experiences in their importance for labour market outcomes in young adults.

Work-family trajectories in young adulthood: Associations with mental health problems in adolescence.

During young adulthood, several transitions in work and family lives occur, but knowledge of the work-family trajectories of the current generation of young adults, i.e. people born in the 1990s, is lacking. Moreover, little is known about whether the mental health status before the start of the working life may shape work-family trajectories. We used 18-year follow-up data from the TRAILS cohort study of individuals born between 1989 and 1991 (n = 992; 63.2% women). Internalising and externalising problems were measured with the Youth Self-Report at ages 11, 13 and 16 years. Monthly employment, education and parenthood states were recorded between 18 and 28 years. Applying sequence analysis, we identified six work-family trajectories in women and men. The first five trajectories were labelled: long education, continuous education and work, education and work to work, early work, and inactive. The main difference between trajectories of women and men was in the timing of parenthood, thus the remaining trajectory of women was labelled active with children, and the remaining trajectory of men active. Women who experienced externalising problems in adolescence were more likely to belong to the trajectory characterised by parenthood. Men who experienced internalising problems in adolescence were more likely to belong to the trajectory characterised by a long time spent in education. The TRAILS data allowed us to consider timing, duration and ordering of the work and family states in young adulthood, and to use multiple assessments of mental health in adolescence. Further research needs to examine the mechanisms through which early mental health affects later work and family outcomes.

Proposing network analysis for early life adversity: An application on life event data.

Commonly used methods for modelling early life adversity (e.g., sum-scores, latent class or trajectory approaches, single-adversity approaches, and factor-analytical approaches) have not been able to capture the complex nature of early life adversity. We propose network analysis as an alternative way of modelling early life adversity (ELA). Our aim was to construct a network of fourteen adverse events (AEs) that occurred before the age of 16 in the TRacking Adolescents Individual Lives Survey (TRAILS, N = 1029). To show how network analysis can provide insight into why AEs are associated, we compared findings from the resulting network model to findings from tetrachoric correlation analyses. The resulting network of ELA comprised direct relationships between AEs and more complex, indirect relationships. A total of fifteen edges emerged in the network of AEs (out of 91 possible edges). The correlation coefficients suggested that many AEs were associated. The network model of ELA indicated, however, that several associations were attributable to interactions with other AEs. For example, the zero-order correlation between parental addiction and familial conflicts (0.24) could be explained by interactions with parental divorce. Our application of network analysis shows that using network analysis for modelling the ELA construct allows capturing the constructs' complex nature. Future studies should focus on gaining more insight into the most optimal model estimation and selection procedures, as well as sample size requirements. Network analysis provides researchers with a valuable tool that allows them as well as policy-makers and professionals to gain insight into potential mechanisms through which adversities are associated with each other, and conjunctively, with life course outcomes of interest.

Work-family trajectories and health: A systematic review.

BACKGROUND: Work and family lives interact in complex ways across individuals' life courses. In the past decade, many studies constructed work-family trajectories, some also examined the relation with health. The aims of this systematic review were to summarise the evidence from studies constructing work-family trajectories, and to synthesise the evidence on the association between work-family trajectories and health. METHODS: We searched MEDLINE, EMBASE, PsycINFO, SocINDEX and Web of Science databases. Key search terms related to work, family and trajectories. Studies that built combined work-family trajectories or examined the relationship between work and family trajectories were included. Risk of bias was assessed independently by two authors. The identified work-family trajectories were summarised and presented for men and women, age cohorts and contexts. The evidence on the association with health as antecedent or consequence was synthesised. RESULTS: Forty-eight studies, based on 29 unique data sources, were included. Thirty-two studies (67%) were published in 2015 or later, and sequence analysis was the primary analytic technique used to construct the trajectories (n = 43, 90%). Trajectories of women were found to be more diverse and complex in comparison with men. Work-family trajectories differed by age cohorts and contexts. Twenty-three studies (48%) examined the association between work-family trajectories and health and most of these studies found significant associations. The results indicate that work-family trajectories characterised by an early transition to parenthood, single parenthood, and weak ties to employment are associated with worse health outcomes. CONCLUSIONS: Work-family trajectories differed greatly between men and women, but differences seemed to decrease in the youngest cohorts. Given the current changes in labour markets and family formation processes, it is important to investigate the work and family lives of younger cohorts. Work-family trajectories were associated with health at different life stages. Future research should examine longitudinal associations of work-family trajectories with health and focus on elucidating why and under which circumstances some trajectories are associated with better or worse health compared with other trajectories.

Barriers and Facilitators for Return to Work from the Perspective of Workers with Common Mental Disorders with Short, Medium and Long-Term Sickness Absence: A Longitudinal Qualitative Study.

Purpose Although common mental disorders (CMDs) highly impact individuals and society, a knowledge gap exists on how sickness absence can be prevented in workers with CMDs. This study explores: (1) workers' perceived causes of sickness absence; (2) perceived return to work (RTW) barriers and facilitators; and (3) differences between workers with short, medium and long-term sickness absence. Methods A longitudinal qualitative study was conducted involving 34 workers with CMDs. Semi-structured interviews were held at two time-points during their RTW process. The 68 interviews were audio-taped, transcribed and thematically analyzed to explore workers' perspective on sickness absence causes, RTW barriers and facilitators, and compare data across the three sub-groups of workers. Results Workers reported various causes for their absence, including: (1) high work pressure; (2) poor work relationships; (3) unhelpful thoughts and feelings, e.g. lacking self-insight; and (4) ineffective coping behaviors. According to workers, RTW was facilitated by work adjustments, fulfilling relationships with supervisors, and adequate occupational health guidance. Workers with short-term leave more often reported favorable work conditions, and proactive coping behavior. In contrast, the long-term group reported reactive coping behavior and dissatisfaction with their work. Conclusion Supporting workers with CMDs in gaining self-awareness and regaining control, discussing the value of their work, and creating work conditions that enable workers to do valuable work, seem central for successful RTW and might prevent sickness absence. Supervisors play a key role in enabling workers to do valuable work and further research should focus on how supervisors can be supported in this task.

Does the timing and duration of mental health problems during childhood and adolescence matter for labour market participation of young adults?

BACKGROUND: Little is known about the timing and duration of mental health problems (MHPs) on young adults' labour market participation (LMP). This life-course study aims to examine whether and how the timing and duration of MHPs between childhood and young adulthood are associated with LMP in young adulthood. METHODS: Logistic regression analyses were performed with data from the Tracking Adolescents' Individual Lives Survey (TRAILS), a Dutch prospective cohort study with 15-year follow-up (N=874). Internalising and externalising problems were measured by the Youth/Adult Self-Report at ages 11, 13, 16, 19 and 22. Labour market participation (having a paid job yes/no) was assessed at age 26. RESULTS: Internalising problems at all ages and externalising problems at age 13, 19 and 22 were associated with an increased risk of not having a paid job (internalising problems ORs ranging from 2.24, 95% CI 1.02 to 4.90 at age 11 to OR 6.58, CI 3.14 to 13.80 at age 22; externalising problems ORs from 2.84, CI 1.11 to 7.27 at age 13 to OR 6.36, CI 2.30 to 17.56 at age 22). Especially a long duration of internalising problems increased the risk of not having a paid job in young adulthood. CONCLUSION: The duration of MHPs during childhood and adolescence is strongly associated with not having paid work in young adulthood. This emphasises the necessity of applying a life-course perspective when investigating the effect of MHPs on LMP. Early monitoring, mental healthcare and the (early) provision of employment support may improve young adult's participation in the labour market.

Identifying return to work trajectories among employees on sick leave due to mental health problems using latent class transition analysis.

OBJECTIVES: To develop effective return to work (RTW) interventions for employees on sick leave due to mental health problems (MHPs), a better understanding of individual variation in the RTW process is needed. We investigated which RTW trajectories can be identified among employees with MHPs in terms of RTW duration and relapse occurrence during the RTW process. Additionally, we examined how different RTW trajectories can be described in terms of personal and work characteristics. METHODS: Longitudinal sickness absence registry data were collected retrospectively from the largest Dutch occupational health service. Quantitative RTW information as well as personal and work characteristics were extracted. In total, 9517 employees with a sickness absence due to MHPs were included in the analyses (62 938 data points; RTW durations from 29 to 730 days). RESULTS: A latent class transition analysis revealed five distinct RTW trajectories, namely (1) fast RTW with little chance of relapse, (2) slow RTW with little chance of relapse, (3) fast RTW with considerable chance of relapse, (4) slow RTW with considerable chance of relapse and (5) very fast RTW with very small chance of relapse. Differences between employees in the slower and faster trajectories were observed regarding gender, age, type of MHP, organisation sector and organisation size but not regarding part-time work. CONCLUSIONS: RTW trajectories among employees with MHPs showed large individual variability and differed on personal and work characteristics. Knowledge on different RTW trajectories and their characteristics contributes to the development of personalised RTW treatments, tailored to specific individuals and organisations.

Investigating young adults' mental health and early working life trajectories from a life course perspective: the role of transitions.

BACKGROUND: Many young adults leave the labour market because of mental health problems or never really enter it, through early moves onto disability benefits. Across many countries of the Organisation for Economic Co-operation and Development, between 30% and 50% of all new disability benefit claims are due to mental health problems; among young adults this moves up to 50%-80%. OUTLINE: We propose a research agenda focused on transitions in building young adults' mental health and early working life trajectories, considering varying views for subgroups of a society. First, we briefly review five transition characteristics, then we elaborate a research agenda with specific research questions. RESEARCH AGENDA: Our research agenda focuses on transitions as processes, in time and place and as sensitive periods, when examining young adults' mental health and early working life trajectories from a life course perspective. As more and more childhood and adolescent cohorts mature and facilitate research on later life labour market, work and health outcomes, transition research can help guide policy and practice interventions. FUTURE CROSS-DISCIPLINARY RESEARCH: In view of the many challenges young adults face when entering the changing world of work and labour markets, future research on transitions in young adults related to their mental health and early working life trajectories will provide ample opportunities for collaborative cross-disciplinary research and stimulate debate on this important challenge.

The Work Role Functioning Questionnaire v2.0 Showed Consistent Factor Structure Across Six Working Samples.

Objective The Work Role Functioning Questionnaire v2.0 (WRFQ) is an outcome measure linking a persons' health to the ability to meet work demands in the twenty-first century. We aimed to examine the construct validity of the WRFQ in a heterogeneous set of working samples in the Netherlands with mixed clinical conditions and job types to evaluate the comparability of the scale structure. Methods Confirmatory factor and multi-group analyses were conducted in six cross-sectional working samples (total N = 2433) to evaluate and compare a five-factor model structure of the WRFQ (work scheduling demands, output demands, physical demands, mental and social demands, and flexibility demands). Model fit indices were calculated based on RMSEA ≤ 0.08 and CFI ≥ 0.95. After fitting the five-factor model, the multidimensional structure of the instrument was evaluated across samples using a second order factor model. Results The factor structure was robust across samples and a multi-group model had adequate fit (RMSEA = 0.63, CFI = 0.972). In sample specific analyses, minor modifications were necessary in three samples (final RMSEA 0.055-0.080, final CFI between 0.955 and 0.989). Applying the previous first order specifications, a second order factor model had adequate fit in all samples. Conclusion A five-factor model of the WRFQ showed consistent structural validity across samples. A second order factor model showed adequate fit, but the second order factor loadings varied across samples. Therefore subscale scores are recommended to compare across different clinical and working samples.

The capability set for work: development and validation of a new questionnaire.

OBJECTIVES: The aim of this study was to develop a questionnaire to measure work capabilities based on Amartya Sen's capability approach and evaluate its validity. METHODS: The development of the questionnaire was based on a combination of qualitative and quantitative methods: interviews, literature study, and an expert meeting. Additionally, in a survey, the validity was evaluated by means of hypotheses testing (using correlations and regression analyses). RESULTS: The questionnaire consists of a set of seven capability aspects for work. For each aspect, it is determined whether it is part of a worker's capability set, ie, when the aspect is considered valuable, is enabled in work, and is realized. The capability set was significantly correlated with work role functioning-flexibility demands (-0,187), work ability (-0.304), work performance (-0.282), worked hours (-0.073), sickness absence (yes/no) (0.098), and sickness absence days (0.105). The capability set and the overall capability item are significantly associated with all work outcomes (P<0.010). CONCLUSIONS: The new capability set for work questionnaire appears to be a valid instrument to measure work capabilities. The questionnaire is unique because the items include the valued aspects of work and incorporate whether a worker is able to achieve what (s)he values in his/her work. The questionnaire can be used to evaluate the capability set of workers in organizations to identify aspects that need to be addressed in interventions.

Process evaluation of a problem solving intervention to prevent recurrent sickness absence in workers with common mental disorders.

Common mental disorders (CMDs) are a major cause of sickness absence. Twenty to 30% of the workers who return to work after sickness absence due to CMDs experience recurrent sickness absence. We developed the Stimulating Healthy participation And Relapse Prevention (SHARP)-at work intervention, a problem solving intervention delivered by occupational physicians (OPs), to prevent recurrent sickness absence in this worker population in The Netherlands. A process evaluation was conducted alongside a cluster-randomised controlled trial to (1) evaluate whether the SHARP-at work intervention was implemented according to the protocol and differed from treatment in the control group, and (2) to investigate the relationship between the key elements of the intervention and the effect outcome (i.e. recurrent sickness absence). We collected process data for both the intervention and control group on recruitment, reach, dose delivered, dose received, fidelity, context and satisfaction. Data on recurrent sickness absence was collected through the registry system of the collaborating occupational health service. The study was performed in the Netherlands, and between 2010 and 2012, 154 OPs and 158 participants participated. Compared to the control group, participants in the intervention group more frequently had two or more consultations with the OP (odds ratio [OR] = 3.2, 95% confidence interval [CI] = 1.2-8.8) and completed more assignments (OR = 33.8, 95% CI = 10.4-109.5) as recommended in the intervention protocol. OPs and participants were satisfied with the intervention and rated it as applicable. Several individual intervention components were linked to the effect outcome. The process evaluation showed that the SHARP-at work intervention was conducted according to the protocol for the majority of the participants and well-received by OPs and participants. Furthermore, the intervention differed from treatment in the control group. Overall, the results provide support for implementing the intervention in practice.

Predictors of recurrent sickness absence among workers having returned to work after sickness absence due to common mental disorders.

OBJECTIVE: The aim of this study was to investigate whether sociodemographic, disease-related, personal, and work-related factors - measured at baseline - are predictors of recurrent sickness absence (SA) at 6 and 12 months follow-up among workers who returned to work after SA due to common mental disorders (CMD). METHODS: Based on a cluster-randomized controlled trial, this prospective study comprised 158 participants, aged 18-63 years, with partial or full return to work (RTW) and an occupational physician-diagnosed CMD. Data on predictors were collected with questionnaires and administrative data. Outcome was the incidence of recurrent SA (ie, decreased work for ≥30% of contract hours due to all-cause SA regardless of partial or full RTW) at 6 and 12 months follow-up. Longitudinal logistic regression analysis with backward elimination was used. RESULTS: We found that company size >100 [odds ratio (OR) 2.59, 95% confidence interval (95% CI) 1.40-4.80] and conflicts with the supervisor (OR 2.21, 95% CI 1.21-4.04) were predictive of recurrent SA. Having ≥1 chronic diseases decreased the risk of recurrent SA (OR 0.54, 95% CI 0.30-0.96). CONCLUSIONS: Two work- and one disease-related factor predicted the incidence of recurrent SA among workers with CMD. Healthcare providers can use these findings to detect and help workers who have returned to work and are at higher risk for recurrent SA. Furthermore, future interventions to prevent recurrent SA could focus on supervisor conflicts.

How to engage occupational physicians in recruitment of research participants: a mixed-methods study of challenges and opportunities.

PURPOSE: To investigate barriers and facilitators for research participant recruitment by occupational physicians (OPs). METHODS: A mixed-methods approach was used. Focus groups and interviews were conducted with OPs to explore perceived barriers and facilitators for recruitment. Based on data of a cluster-randomised controlled trial (cluster-RCT), univariate and multivariate analyses were conducted to investigate associations between OPs' personal and work characteristics and the number of recruited participants for the cluster-RCT per OP. RESULTS: Perceived barriers and facilitators for recruitment were categorised into: study characteristics (e.g. concise inclusion criteria); study population characteristics; OP's attention; OP's workload; context (e.g. working at different locations); and OP's characteristics (e.g. motivated to help). Important facilitators were encouragement by colleagues and reminders by information technology tools. Multivariate analyses showed that the number of OPs within the clinical unit who recruited participants was positively associated with the number of recruited participants per OP [rate ratio of 1.43, 95 % confidence interval 1.24-1.64]. CONCLUSIONS: When mobilising OPs for participant recruitment, researchers need to engage entire clinical units rather than approach OPs on an individual basis. OPs consider regular communication, especially face-to-face contact and information technology tools serving as reminders, as helpful.

Prevention of recurrent sickness absence in workers with common mental disorders: results of a cluster-randomised controlled trial.

OBJECTIVES: Workers with common mental disorders (CMDs) frequently experience recurrent sickness absence but interventions to prevent this are lacking. The goal of this study was to evaluate the effectiveness of the Stimulating Healthy participation And Relapse Prevention at work intervention in preventing recurrent sickness absence in workers who returned to work after sickness absence due to CMDs. METHODS: We performed a cluster-randomised controlled trial with 3 months, 6 months and 12 months follow-up. Treatment providers were randomised to either a 2-day training in the Stimulating Healthy participation And Relapse Prevention at work intervention, that is, a problem-solving intervention, or usual care. Primary outcome measures were the incidence of recurrent sickness absence and time to recurrent sickness absence. Secondary outcome measures were mental health complaints, work functioning and coping behaviour. RESULTS: 80 participants were randomised in the intervention group and 78 in the control group. The adjusted OR for the incidence of recurrent sickness absence was 0.40 (95% CI 0.20 to 0.81) and the adjusted HR for time to recurrent sickness absence was 0.53 (95% CI 0.33 to 0.86) for the intervention group compared with care as usual. CONCLUSIONS: This study demonstrates the 12-month effectiveness of a problem-solving intervention for reducing recurrent sickness absence in workers with CMDs and emphasises the importance of continuous attention in the post return to work phase for workers who have been on sickness absence due to CMDs.

Economic evaluation of a problem solving intervention to prevent recurrent sickness absence in workers with common mental disorders.

OBJECTIVES: Workers with common mental disorders (CMDs) frequently experience recurrent sickness absence but scientifically evaluated interventions to prevent recurrences are lacking. The objectives of this study are to evaluate the cost-effectiveness and cost-benefit of a problem solving intervention aimed at preventing recurrent sickness absence in workers with CMDs compared to care as usual. METHODS: An economic evaluation was conducted alongside a cluster-randomised controlled trial with 12 months follow-up. Treatment providers were randomised to either a 2-day training in the SHARP-at work intervention, i.e. a problem solving intervention, or care as usual. Effect outcomes were the incidence of recurrent sickness absence and time to recurrent sickness absence. Self-reported health care utilisation was measured by questionnaires. A cost-effectiveness analysis (CEA) from the societal perspective and a cost-benefit analysis (CBA) from the employer's perspective were conducted. RESULTS: The CEA showed that the SHARP-at work intervention was more effective but also more expensive than care as usual. The CBA revealed that employer's occupational health care costs were significantly higher in the intervention group compared to care as usual. Overall, the SHARP-at work intervention showed no economic benefit compared to care as usual. CONCLUSIONS: As implementation of the SHARP-at work intervention might require additional investments, health care policy makers need to decide if these investments are worthwhile considering the results that can be accomplished in reducing recurrent sickness absence.

Interventions to facilitate return to work in adults with adjustment disorders.

BACKGROUND: Adjustment disorders are a frequent cause of sick leave and various interventions have been developed to expedite the return to work (RTW) of individuals on sick leave due to adjustment disorders. OBJECTIVES: To assess the effects of interventions facilitating RTW for workers with acute or chronic adjustment disorders. SEARCH METHODS: We searched the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) to October 2011; the Cochrane Central Register of Controlled Trials (CENTRAL) to Issue 4, 2011; MEDLINE, EMBASE, PsycINFO and ISI Web of Science, all years to February 2011; the WHO trials portal (ICTRP) and ClinicalTrials.gov in March 2011. We also screened reference lists of included studies and relevant reviews. SELECTION CRITERIA: We selected randomised controlled trials (RCTs) evaluating the effectiveness of interventions to facilitate RTW of workers with adjustment disorders compared to no or other treatment. Eligible interventions were pharmacological interventions, psychological interventions (such as cognitive behavioural therapy (CBT) and problem solving therapy), relaxation techniques, exercise programmes, employee assistance programmes or combinations of these interventions. The primary outcomes were time to partial and time to full RTW, and secondary outcomes were severity of symptoms of adjustment disorder, work functioning, generic functional status (i.e. the overall functional capabilities of an individual, such as physical functioning, social function, general mental health) and quality of life. DATA COLLECTION AND ANALYSIS: Two authors independently selected studies, assessed risk of bias and extracted data. We pooled studies that we deemed sufficiently clinically homogeneous in different comparison groups, and assessed the overall quality of the evidence using the GRADE approach. MAIN RESULTS: We included nine studies reporting on 10 psychological interventions and one combined intervention. The studies included 1546 participants. No RCTs were found of pharmacological interventions, exercise programmes or employee assistance programmes. We assessed seven studies as having low risk of bias and the studies that were pooled together were comparable. For those who received no treatment, compared with CBT, the assumed time to partial and full RTW was 88 and 252 days respectively. Based on two studies with a total of 159 participants, moderate-quality evidence showed that CBT had similar results for time (measured in days) until partial RTW compared to no treatment at one-year follow-up (mean difference (MD) -8.78, 95% confidence interval (CI) -23.26 to 5.71). We found low-quality evidence of similar results for CBT and no treatment on the reduction of days until full RTW at one-year follow-up (MD -35.73, 95% CI -113.15 to 41.69) (one study with 105 participants included in the analysis). Based on moderate-quality evidence, problem solving therapy (PST) significantly reduced time until partial RTW at one-year follow-up compared to non-guideline based care (MD -17.00, 95% CI -26.48 to -7.52) (one study with 192 participants clustered among 33 treatment providers included in the analysis), but we found moderate-quality evidence of no significant effect on reducing days until full RTW at one-year follow-up (MD -17.73, 95% CI -37.35 to 1.90) (two studies with 342 participants included in the analysis). AUTHORS' CONCLUSIONS: We found moderate-quality evidence that CBT did not significantly reduce time until partial RTW and low-quality evidence that it did not significantly reduce time to full RTW compared with no treatment. Moderate-quality evidence showed that PST significantly enhanced partial RTW at one-year follow-up compared to non-guideline based care but did not significantly enhance time to full RTW at one-year follow-up. An important limitation was the small number of studies included in the meta-analyses and the small number of participants, which lowered the power of the analyses.

Prevention of recurrent sickness absence among employees with common mental disorders: design of a cluster-randomised controlled trial with cost-benefit and effectiveness evaluation.

BACKGROUND: Common mental disorders, such as depression, anxiety disorder, and adjustment disorder, have emerged as a major public and occupational health problem in many countries. These disorders can have severe consequences such as absenteeism and work disability. Different interventions have been developed to improve the return-to-work of employees with common mental disorders, but still a large proportion of employees experiences health and work problems after their return-to-work. For this reason, the SHARP-at work intervention is developed to prevent a relapse of sickness absence among employees who have returned to work after a period of sickness absence because of common mental disorders. We aim to evaluate the effectiveness, cost-benefit and process of the intervention compared to care as usual. METHODS/DESIGN: The study is designed as a cluster-randomised controlled trial with randomisation at the level of the occupational physician. Employees who have returned to work after a period of sickness absence because of a common mental disorder are included in the study. Employees in the intervention group will receive the SHARP-at work intervention. The intervention focusses on active guidance of employees by occupational physicians during the first weeks of work after sickness absence. Employees in the control group will receive care as usual. Outcomes will be assessed at baseline and at 3, 6, and 12 months follow-up. The primary outcome is cumulative recurrent sickness absence days. Secondary outcome measures are mental health, work functioning, and coping. Adherence to the protocol, communication between stakeholders, and satisfaction with the treatment are the process measures assessed in both study groups. Cost-benefit is calculated from a societal perspective. Finally, prognostic factors for a relapse of sickness absence are investigated. DISCUSSION: This study goes beyond return-to-work by focussing on the prevention of recurrent sickness absence. The study incorporates not only outcomes on sickness absence and mental health but also on health-related work functioning. The results of this study can contribute to a further development of practice guidelines and the promotion of sustainable work participation. TRIAL REGISTRATION: NTR1963.