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1.
Integr Cancer Ther ; 20: 15347354211058678, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34818921

RESUMO

BACKGROUND: Preoperative hypnosis has shown promising effects in controlling side effects from breast cancer surgery, but the feasibility and effects are largely unknown outside the US. METHODS: A mixed-methods approach was applied involving a large-scale population survey and a small-scale pilot study. The survey assessed attitudes toward hypnosis in a representative sample from the general population (n = 1049), while the pilot study involved interviews with 5 women who received hypnosis prior to mastectomy/lumpectomy. RESULTS: In the survey, 8% reported to have previous experience with hypnosis, and 67% reported willingness to accept hypnosis in a medical setting. Increasing age was associated with more skepticism, while previous experience was associated with less skepticism. In the pilot study, 4 themes were identified: (1) caretaking, (2) experiences related to hypnosis, (3) thoughts and feelings related to diagnosis, and (4) surgery. All participants reported positive experiences related to hypnosis, and none described unpleasant side effects or postoperative pain (pain intensity > 3) after surgery. CONCLUSIONS: The results indicate that the general public is positive toward clinical hypnosis as a supplement to medical treatment and that preoperative hypnosis is feasible in Norwegian breast cancer patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04300283.

2.
Trials ; 22(1): 854, 2021 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-34838125

RESUMO

BACKGROUND: Common mental disorders such as depression and anxiety are major contributors to the global burden of disease. Affected individuals suffer reduced quality of life, impaired functioning and reduced capacity to work. Maintaining employment is an important determinant for health and wellbeing, and the economic impact of depression and anxiety is a significant societal expense. Treatments providing effective symptom reduction and helping patients return to work (RTW) would thus have substantial public health benefits. The present study will explore the effectiveness of metacognitive therapy (MCT) and work-focused interventions on reducing symptoms and increasing RTW rates for patients on sick leave due to depression and anxiety. METHODS: The study is a randomised controlled wait-list trial (RCT; N = 240). The intervention group will receive protocol-based MCT and work-focused interventions immediately after inclusion. The control condition is a wait-list control group. All patients will receive up to 12 weekly sessions. The study context is a Norwegian outpatient clinic part of a national programme aimed at reducing sick leave. The co-primary outcomes are change in RTW and symptoms of depression and anxiety at the end of treatment. In addition to self-report, sick leave will also be collected from national registries from 2 years prior to intervention to 4 years after intervention. Symptoms of scores will be collected by self-report at pre- and post-treatment and at 6 and 12 months follow-up after treatment. A cost-effectiveness analysis will use total cost and quality-adjusted life-years as the secondary outcomes. DISCUSSION: There is broad consensus on the importance of identifying treatment that effectively reduces depression and anxiety symptoms and aids RTW. This study is an important contribution to the field as it is the first RCT on MCT and work-focused interventions for patients on sick leave due to anxiety and depression. TRIAL REGISTRATION: ClinicalTrials.gov NCT03301922 . Registered on October 4, 2017.


Assuntos
Depressão , Licença Médica , Ansiedade/diagnóstico , Ansiedade/terapia , Transtornos de Ansiedade , Depressão/diagnóstico , Depressão/terapia , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
Artigo em Inglês | MEDLINE | ID: mdl-34633483

RESUMO

OBJECTIVE: In this study, we examined exposure to workplace bullying as a predictor of registry-based benefit recipiency among workers struggling with work participation due to common mental disorders. Further, we examined if the experience of receiving social support moderated the association between workplace bullying and benefit recipiency. DESIGN: Secondary analyses of a randomized controlled trial. PATIENTS: People struggling with work participation due to common mental disorders (CMD). METHODS: Study participants (n = 1193) were from a randomized controlled trial (The At Work and Coping trial (AWaC), trial registration http://www.clinicaltrials.gov NCT01146730), and self-reported CMD as a main obstacle for work participation. Participants were at risk of sickness absence, currently on sickness absence or on long-term benefits. Benefit recipiency indicated sickness absence and/or long-term benefits (i.e., disability pension) at 6-month follow-up. RESULTS: Of the 1193 participants, 36% reported exposure to workplace bullying. Workplace bullying was significantly associated with benefit recipiency at 6-month follow-up (OR 1.41, CI 1.11-1.79). Social support did not moderate the association between bullying and benefit recipiency. CONCLUSIONS: The finding that workplace bullying increases the risk of later benefit recipiency suggest that bullying is a significant obstacle for work participation.

4.
Trials ; 22(1): 705, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34654464

RESUMO

BACKGROUND: Employment is associated with better outcomes of substance use treatment and protects against relapse after treatment completion. Unemployment rates are high for people with substance use disorders (SUD) who undergo treatment, with Norwegian estimates ranging from 81 to 91%. Evidence-based vocational models are lacking for patients in SUD treatment but exist for patients with psychosis in terms of Individual Placement and Support (IPS). The aim of the IPS for substance use disorders (IPS-SUD) trial is to investigate the effect of IPS in a SUD population. METHODS/DESIGN: The IPS-SUD trial is a randomized controlled trial (RCT) comparing IPS to an enhanced control intervention. The study is a seven-site, two-arm, pragmatic, parallel-group, superiority RCT. Participants are randomly assigned (1:1) to receive either IPS plus treatment as usual (TAU) or to receive a self-help guide book and 12-h workshop plus 1-h individual vocational guidance plus TAU. Aiming to recruit 200 participants, we will be able to detect a 20% difference in the main outcome of employment with 90% power. We will make assessments at inclusion and at 6- and 12-month follow-ups and obtain outcome data on employment from national mandatory registries. The primary outcome will be at least 1 day of competitive employment during the 18-month follow-up period. Secondary employment outcomes will capture the pattern and extent of employment in terms of total time worked (days/hours), time to first employment, number of different jobs, duration of the longest employment, and sustained employment. Secondary non-employment outcomes will be substance use, mental distress, and quality of life measured by validated instruments at 6, 12, and 18 months follow-up assessments. To be eligible, participants must be between 18 and 65 years, currently unemployed and in treatment for SUD. DISCUSSION: The IPS-SUD trial will provide evidence for the use of IPS in a SUD population. Findings from the study will have implications for service delivery. TRIAL REGISTRATION: ClinicalTrials.gov NCT04289415 . Registered on February 28, 2020.


Assuntos
Readaptação ao Emprego , Transtornos Mentais , Transtornos Psicóticos , Transtornos Relacionados ao Uso de Substâncias , Emprego , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reabilitação Vocacional , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/terapia , Desemprego
5.
Front Psychol ; 12: 630422, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33833718

RESUMO

Chronic post-surgical pain (CPSP) represents a highly prevalent and significant clinical problem. Both major and minor surgeries entail risks of developing CPSP, and cancer-related surgery is no exception. As an example, more than 40% of women undergoing breast cancer surgery struggle with CPSP years after surgery. While we do not fully understand the pathophysiology of CPSP, we know it is multifaceted with biological, social, and psychological factors contributing. The aim of this review is to advocate for the role of response outcome expectancies in the development of CPSP following breast cancer surgery. We propose the Cognitive Activation Theory of Stress (CATS) as an applicable theoretical framework detailing the potential role of cortisol regulation, inflammation, and inflammatory-induced sickness behavior in CPSP. Drawing on learning theory and activation theory, CATS offers psychobiological explanations for the relationship between stress and health, where acquired expectancies are crucial in determining the stress response and health outcomes. Based on existing knowledge about risk factors for CPSP, and in line with the CATS position, we propose the SURGEry outcome expectancy (SURGE) model of CPSP. According to SURGE, expectancies impact stress physiology, inflammation, and fear-based learning influencing the development and persistence of CPSP. SURGE further proposes that generalized response outcome expectancies drive adaptive or maladaptive stress responses in the time around surgery, where coping dampens the stress response, while helplessness and hopelessness sustains it. A sustained stress response may contribute to central sensitization, alterations in functional brain networks and excessive fear-based learning. This sets the stage for a prolonged state of inflammatory-induced sickness behavior - potentially driving and maintaining CPSP. Finally, as psychological factors are modifiable, robust and potent predictors of CPSP, we suggest hypnosis as an effective intervention strategy targeting response outcome expectancies. We here argue that presurgical clinical hypnosis has the potential of preventing CPSP in women with breast cancer.

6.
J Occup Rehabil ; 31(4): 699-710, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33661452

RESUMO

PURPOSE: To investigate the effect of Individual Placement and Support (IPS) according to diagnoses of schizophrenia, bipolar disorder, major depression, substance use disorders, or forensic psychiatric conditions. METHODS: A systematic search of the literature was conducted in June 2017 and repeated in December 2020. The systematic review included 13 studies. Analyses of pooled original data were based on the six studies providing data (n = 1594). No studies on forensic psychiatric conditions were eligible. Hours and weeks worked were analyzed using linear regression. Employment, and time to employment was analyzed using logistic regression, and cox-regression, respectively. RESULTS: The effects on hours and weeks in employment after 18 months were comparable for participants with schizophrenia, and bipolar disorder but only statistically significant for participants with schizophrenia compared to services as usual (SAU) (EMD 109.1 h (95% CI 60.5-157.7), 6.1 weeks (95% CI 3.9-8.4)). The effect was also significant for participants with any drug use disorder (121.2 h (95% CI 23.6-218.7), 6.8 weeks (95% CI 1.8-11.8)). Participants with schizophrenia, bipolar disorder, and any drug use disorder had higher odds of being competitively employed (OR 2.1 (95% CI 1.6-2.7); 2.4 (95% CI 1.3-4.4); 3.0 (95% CI 1.5-5.8)) and returned to work faster than SAU (HR 2.1 (95% CI 1.6-2.6); 1.8 (95% CI 1.1-3.1); 3.0 (95% CI 1.6-5.7)). No statistically significant effects were found regarding depression. CONCLUSIONS: IPS was effective regarding schizophrenia, bipolar disorder, and substance use disorder; however, the effect on hours, and weeks worked was not statistically significant regarding bipolar disorder. For people with depression the impact of IPS remains inconclusive. Non-significant results may be due to lack of power. TRIAL REGISTRATION: PROSPERO protocol nr. CRD42017060524.


Assuntos
Transtorno Depressivo , Readaptação ao Emprego , Transtornos Mentais , Esquizofrenia , Transtornos Relacionados ao Uso de Substâncias , Humanos , Reabilitação Vocacional
7.
Scand J Public Health ; : 1403494821990241, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33573521

RESUMO

AIMS: To develop a questionnaire to examine attitudes among employees and managers to include people with various health problems into their work group, and to test the questionnaire in one relevant population within the labour market. METHODS: A questionnaire was developed through a process involving discussions in a scientific forum and pilot testing with group discussions. The final questionnaire, which was tested in a survey study of managers and employees in 33 Norwegian kindergartens (N=485), contained 10 short case stories followed by questions concerning workplace inclusion. The case stories described individuals with musculoskeletal and mental disorders, as well as individuals with potentially stigmatising behavioural history and lifestyle, and control cases. Risk ratios with 95% confidence intervals (CIs) were used to compare the case stories. Cases with high risk ratios had an increased risk of not being included compared to a control case. RESULTS: Attitudes for workplace inclusion varied between the different case stories. Cases portraying mental illness had the highest risk ratios, indicating that employees and managers are less likely to include people with mental illness than people with musculoskeletal illness. Furthermore, unspecific or chronic illness had higher risk ratios than specific and acute illness. The most important barriers also varied between case stories. CONCLUSIONS: The workplace inclusion questionnaire fulfills the need for a quantitative measure of attitudes to include individuals with various health problems into the workplace. Comparison of risk ratios showed clear differences between case stories, indicating that the workplace inclusion questionnaire is a valuable tool to measure the variance in workplace inclusion.

11.
Scand J Pain ; 20(3): 591-602, 2020 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-32469334

RESUMO

Background and aims A considerable research-literature focuses on pain during labor and associations with postpartum persistent pain and depression, with findings pointing in various directions. The aim of this study was to examine the role of labor pain and overall birth experience in the development of pain and depression 8 weeks after delivery. Methods The study sample was drawn from the Akershus Birth Cohort. Data from multiple sources were used, including the hospital's birth record (n = 4,391), questionnaire data from gestational week 17 of pregnancy (n = 3,752), 8 weeks postpartum (n = 2,217), and two questions about pain and birth experience asked within 48 h after delivery (n = 1,221). The Edinburgh Postnatal Depression Scale was used to measure postpartum depression, a single question was used to measure persistent pain 8 weeks postpartum, while pain and birth experience were measured by numeric rating scales. A history of pre-pregnant depression and chronic pain were measured through self-report questions in gestational week 17. A total of 645 women had complete data from all sources. We applied multiple imputation techniques to handle missing responses on the two questions about pain and birth experience. Results The results showed that neither labor pain nor birth experience were associated with persistent pain 8 weeks postpartum, whereas pain before pregnancy (OR 3.70; 95% CI 2.71-5.04) and a history of depression (OR 2.31; 95% CI 1.85-2.88) were statistically significant predictors of persistent pain. A negative birth experience was significantly (OR 1.16; 95% CI 1.04-1.29) associated with postpartum depression, whereas labor pain intensity was not. A history of depression (OR 3.95; 95% CI 2.92-5.34) and pre-pregnancy pain (OR 2.03; 95% CI 1.37-3.01) were important predictors of postpartum depression 8 weeks after delivery. Conclusions and implications Whilst the relationship between labor pain intensity and postpartum pain and depression remain unclear, our results do imply the need to screen for previous depression and chronic pain conditions in pregnant women, as well as consider preventive measures in those who screen positive.


Assuntos
Parto Obstétrico/efeitos adversos , Depressão Pós-Parto/epidemiologia , Dor do Parto/epidemiologia , Parto/psicologia , Adulto , Dor Crônica/diagnóstico , Depressão Pós-Parto/diagnóstico , Feminino , Humanos , Incidência , Estudos Longitudinais , Medição da Dor , Gravidez , Estudos Prospectivos , Inquéritos e Questionários
12.
Front Psychol ; 11: 749, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32431641

RESUMO

Introduction: Comorbid posttraumatic stress disorder (PTSD) in patients with chronic pain may have a negative effect on the course and outcome of both disorders. Nevertheless, the co-occurrence of the two conditions is often overlooked in clinical settings. Further, little is known about how PTSD is associated with biopsychosocial characteristics in this patient group. The first objective was to assess the prevalence of posttraumatic stress symptoms (PTSS) in patients with chronic pain in a Norwegian university hospital outpatient pain clinic. The second objective was to investigate possible associations between PTSS and adverse outcomes such as pain intensity, disability, and distress. The third objective was to compare the PTSS prevalence rates between primary versus secondary pain conditions. Materials and methods: Six hundred and ninety-two patients meeting for pain assessment completed self-report questionnaires about PTSS and possibly associated factors. The Life Events Checklist and the Stressful Life Events Screening Questionnaire were used to screen for potentially traumatic life events. The Impact of Events Scale - Revised and the PTSD Checklist for DSM-5 were used to assess PTSS. Differences between patients with and without severe PTSS on the possibly associated variables were analyzed by chi-squared-, and t-tests. Results: 20.7% of the participants reported a level of PTSS qualifying for a PTSD diagnosis. These patients reported higher levels of pain intensity, pain bothersomeness, disability, and psychological distress, as well as lower levels of self-efficacy. They also reported higher levels of pain catastrophizing, perceived injustice, fatigue, and sleep difficulties. Finally, there was not a significant difference in prevalence rates between primary and secondary pain conditions. Discussion: PTSS are frequent in patients with chronic pain, and a range of psychological characteristics is associated with a high level of such symptoms in this patient group. Patients with both conditions report a significantly higher symptom load, and the potential impact on the individual's life is major. In terms of pain condition, there were no differences in PTSS between primary pain conditions and secondary pain conditions in this pain population. This study emphasizes the importance of increased attention on PTSS when seeing patients with chronic pain conditions in clinical practice.

13.
Psychiatr Rehabil J ; 43(1): 9-17, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30945917

RESUMO

OBJECTIVE: Norway is a high-income and high-cost society with a generous welfare system, and it has the largest mental health-related unemployment gap of the OECD countries. The aim of the current article was to present a short history of Individual Placement and Support (IPS) services to increase work participation in Norway. METHOD: We provide a narrative overview of the developments and research on IPS in Norway, from the introduction of supported employment to recent and ongoing randomized controlled trials (RCTs) investigating the effectiveness of IPS for various target groups. FINDINGS: While vocational rehabilitation services in Norway have traditionally followed a train-then-place approach, the introduction of supported employment in the early 1990s led to a range of new initiatives to increase work participation. Early implementations were inspired by supported employment but did not follow the evidence-based IPS methodology. More recent developments include a shift toward evidence-based IPS, and the first Norwegian RCT of IPS showed effectiveness on both work- and health-related outcomes among people with moderate to severe mental illness. Several ongoing trials are currently investigating IPS for new target groups, including chronic pain patients and refugees. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The results suggest that IPS is more effective than traditional approaches to increase work participation, even in the Norwegian context of a high-cost welfare society. IPS has shown effectiveness in severe as well as more common types of mental illness in Norway, and results from ongoing trials will further reveal whether IPS may be expanded to various new target groups. (PsycINFO Database Record (c) 2020 APA, all rights reserved).


Assuntos
Readaptação ao Emprego , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Reabilitação Psiquiátrica , Reabilitação Vocacional , Readaptação ao Emprego/história , História do Século XX , História do Século XXI , Humanos , Noruega , Reabilitação Psiquiátrica/história , Reabilitação Vocacional/história
14.
Tidsskr Nor Laegeforen ; 139(11)2019 Aug 20.
Artigo em Norueguês, Inglês | MEDLINE | ID: mdl-31429250

RESUMO

BACKGROUND: The Return-To-Work Self-Efficacy Scale questionnaire maps self-efficacy upon return to work following acute lower back pain. We wished to translate and validate the questionnaire, as well as to assess the concordance between the translated form and two other forms. MATERIAL AND METHOD: The questionnaire was translated into Norwegian according to recommended guidelines. Employees in the health and care service with musculoskeletal symptoms were recruited for the study. Cross-cultural validity was assessed by principal component analysis and internal consistency by Cronbach's alpha. Conceptual validity was assessed by correlation between the translated form and simultaneous measurements from two questionnaires that focus on closely related characteristics: the Tampa scale for kinesiophobia and the Demand-ControlSupport model. RESULTS: The Norwegian questionnaire is called 'Job-related self-efficacy'. Of a sample of 229 persons, 206 (89.9 %) were included in the analyses. Principal component analysis supported cross-cultural validity through findings of a three-factor structure in accordance with the original questionnaire. Internal consistency was high for all questions in the questionnaire (0.95), as well as for each of the three factors: meet job requirements (0.99), communicate needs to others (0.97) and adapt work duties (0.96), after adjusting for the number of questions. There were low correlations (< 0.40) between Job-Related Self-Efficacy and the Tampa scale for kinesiophobia, and the various factors in the Demand-Control-Support questionnaire, respectively. INTERPRETATION: The 'Job-Related Self-Efficacy' questionnaire has satisfactory cross-cultural validity after it was translated, and satisfactory internal consistency.


Assuntos
Dor Lombar/psicologia , Doenças Musculoesqueléticas/psicologia , Retorno ao Trabalho/psicologia , Autoeficácia , Inquéritos e Questionários , Adulto , Idoso , Dor Crônica/psicologia , Comparação Transcultural , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/psicologia , Noruega , Saúde do Trabalhador , Medição da Dor , Reprodutibilidade dos Testes , Licença Médica , Apoio Social , Traduções , Estados Unidos , Desempenho Profissional , Carga de Trabalho/psicologia , Adulto Jovem
17.
Scand J Pain ; 19(2): 365-373, 2019 04 24.
Artigo em Inglês | MEDLINE | ID: mdl-30699072

RESUMO

Background and aims Chronic pain is a leading cause to years lived with disability worldwide. However, few of the interventions used in pain medicine have proven efficacy, and evidence from the existing studies may not be valid for the general pain population. Therefore, it is of utmost need that we describe chronic pain conditions in their most relevant aspects, their various guises, as well as the real world outcomes of our clinical interventions. The most obvious and crude way to make these assessments are through large registries where patient characteristics, treatment characteristics (including but not limited to what, when, how often and by whom), treatment outcomes and patient outcomes are scrutinized and recorded. Methods and results This article describes in detail the design and baseline data of the comprehensive Oslo University Hospital Pain Registry (OPR). OPR is the local registry of the largest university and interdisciplinary outpatient pain clinic in Norway. Data registration started in October 2015, and approximately 1,000 patients are assessed and treated at the clinic each year. During the first 2 years of running the OPR (through September 2017), a total of 1,712 patient baseline reports were recorded from 2,001 patients. Clinicians enter data about relevant treatments and interventions, while patients provide self-reported data on aspects related to pain and pain management. The patients complete an electronic registration immediately before their first consultation at the outpatient pain clinic. The baseline questions of the OPR cover: Basic demographics; The Modified Oswestry Disability Index to assess general function; A pain drawing to assess pain location; Questions regarding the temporal aspects of pain; Six 0-10 Numeric Rating Scales to assess pain intensity and bothersomeness; The EQ-5D-5L to measure health-related quality of life; The Hopkins Symptom Check List-25 to assess psychological distress; A single question about self-rated health; The general self-efficacy scale to assess the patient's perceived self-efficacy; The Bodily Distress Syndrome checklist to assess functional disorders; The Injustice Experience Questionnaire to assess whether the patients experience injustice; Chalder Fatigue Questionnaire to assess fatigue; The Insomnia Severity Index to assesses the levels of insomnia symptoms; The Pain Catastrophizing Scale to measure pain catastrophizing and exaggerated negative orientation toward pain stimuli and pain experience; And the SF36v2 to assess patients' self-report of generic health and wellbeing. The baseline data show that chronic pain patients have a high degree of negative impact in all aspects of their lives. Conclusions and implications The OPR is the most comprehensive pain registry for multidisciplinary and interdisciplinary outpatient pain clinics in Norway. Detailed design of the registry and key baseline data are presented. Registries are of great value in that they enable real world effectiveness outcomes for patients with chronic pain conditions. The OPR can thus serve as a model for similar initiatives elsewhere. The OPR cohort may also serve as a historical control in future studies, both with experimental and observational design.


Assuntos
Dor Crônica , Hospitais Universitários , Medição da Dor , Sistema de Registros , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Inquéritos e Questionários
18.
Scand J Work Environ Health ; 45(1): 33-41, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30074050

RESUMO

Objectives The aim of this study was to evaluate the effectiveness of individual placement and support (IPS) for people struggling with work participation due to moderate-to-severe mental illness. The study was conducted in Norway, a setting characterized by a comprehensive welfare system and strong employment protection legislation. Methods A randomized controlled multicenter trial including 410 participants was conducted. The intervention group received IPS according to the IPS manual. The control group received high-quality usual care. The main outcome was competitive employment at 12- and 18-months follow-up, based on objective registry data. Changes in mental health and health-related quality of life were secondary outcomes. Results At 12-months follow-up, 36.6% of participants in the IPS group and 27.1% of participants in the control group were in competitive employment, while the difference was slightly higher (37.4% versus 27.1%) at 18-months follow-up. Furthermore, IPS yielded positive effects on all the secondary outcomes compared to the control group (all P<0.05). Conclusions The IPS model of supported employment was superior to high-quality usual care on both vocational and non-vocational outcomes for people with moderate-to-severe mental illness, even in a policy context characterized by high job security and a comprehensive welfare system.


Assuntos
Readaptação ao Emprego , Transtornos Mentais/reabilitação , Reabilitação Vocacional , Adulto , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Noruega , Qualidade de Vida
19.
BMC Public Health ; 18(1): 1176, 2018 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-30326872

RESUMO

BACKGROUND: Young adults that are not in education, training or employment represent a problem across European countries. While some are cases of temporary transitions or short-term inactivity, others represent a more vulnerable group at risk of early work disability. Early exclusion from the labor market represents long lives exposed to detrimental effects of unemployment on health and well-being, and constitutes an economic burden for society. There is need for more knowledge about young adults who are at risk of early work disability but have not yet reached the point of more permanent exclusion. This study aims to investigate social and health-related problems in a Norwegian sample of young adults at risk of early work disability, and their self-perceived causes of illness. METHODS: Baseline data from participants in the SEED-trial (N = 96), a randomized controlled trial comparing individual placement and support to traditional vocational rehabilitation in young adults at risk of early work disability, were analyzed. Background, health behaviors, adverse social experiences, disability level, physical and mental health, social support, coping, and self-perceived causal attributions of illness were measured. Gender differences were analyzed using chi-square and t-tests. RESULTS: Mean age was 24, and 68% were men. One third reported reading and writing difficulties, and 40% had less than high-school education. The majority had experienced bullying (66%) or violence (39%), and 53% reported hazardous alcohol use. Psychological distress was the most prevalent health problem (52%), and women generally had more physical and mental health problems than men. Self-perceived causal attributions of illness were mainly related to relational problems, followed by health behaviors, heredity/genetics, and external environmental factors. CONCLUSIONS: The study provides a deeper insight into a vulnerable group with substantial challenges related to adverse social experiences, psychological distress, and alcohol use, who emphasized relational problems as the main causal factor for their illness. Findings suggest a need for broader focus on psychological and social factors in vocational rehabilitation efforts targeting young adults at risk of early work disability. Furthermore, gender-specific approaches may be warranted and should be followed up in future studies. TRIAL REGISTRATION: Clinicaltrials.gov: NCT02375074 . Retrospectively registered December 3rd 2014.


Assuntos
Pessoas com Deficiência , Adolescente , Adulto , Feminino , Humanos , Masculino , Noruega , Fatores de Risco , Fatores Sexuais , Evasão Escolar , Desemprego , Adulto Jovem
20.
Occup Environ Med ; 75(10): 703-708, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30032103

RESUMO

BACKGROUND: There is moderate quality evidence that integrating work-directed interventions and components from psychological therapies reduces sickness absence in the medium term. We aimed to extend this evidence by examining objectively ascertained income and work participation status up to 4 years after an intervention to improve outcomes among people who struggle with work from common mental disorder. METHODS: The intervention combined components from cognitive behavioural therapy with principles from supported employment, and compared its efficacy with usual care. Outcomes were derived from registry data with no attrition, in a pragmatic multisite randomised controlled trial (N=1193). RESULTS: The intervention group had higher income, higher work participation and more months without receiving benefits over the 10-month to 46-month long-term follow-up period after end of treatment, but differences were not statistically significant. For the group on long-term benefits at inclusion, effect sizes were larger and statistically significant. CONCLUSION: There were no statistically significant differences between the two groups in the primary outcome in the total population. In a secondary analysis for the subgroup most at risk of permanent work exclusion, long-term outcomes were favourable in the intervention group compared with usual care. The results support integrated work and health services for people on the severe end of work participation challenges. TRIAL REGISTRATION NUMBER: NCT01146730.


Assuntos
Absenteísmo , Terapia Cognitivo-Comportamental , Readaptação ao Emprego/métodos , Renda , Benefícios do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Transtornos Mentais/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Adulto Jovem
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