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Introduction Common mental disorders (CMD) such as depression, anxiety and adjustment disorder are highly prevalent and constitute a major cause of (long-term) sick leave. Considering the negative consequences of long-term sick leave it is important that effective return to work (RTW) interventions are implemented for workers with CMD. Evidence about effective interventions and their mechanisms of change is still limited, especially with respect to mental health care (MHC) interventions. This dissertation evaluated the effectiveness of a MHC intervention on RTW and studied the (mediating) role of RTW self-efficacy (RTW-SE) in the RTW process of workers with CMD. RTW-SE refers to the confidence employees have in their abilities to return to the workplace and perform their job successfully. Role of self-efficacy in the RTW process A RTW-SE measure was developed and validated among employees on sick leave (n=2214). Results showed that the RTW-SE scale was a reliable and valid instrument. In addition, results from descriptive and multilevel-analysis among 168 employees on sick leave with CMD showed that RTW-SE increased over time in a cuvelinear and generally wave-like pattern before full RTW occurred. Full RTW did occur on average when participants scored between 3.8-4.5 (on a scale from 1-6). Moreover, this dissertation is the first to show that increased RTW-SE predicts faster full RTW, irrespective of baseline self-efficacy levels. Therefore, we recommend the use of theoretical models that include self-efficacy for the design and evaluation of RTW interventions. In addition, self-efficacy scores may be used in practice to monitor RTW-readiness and offer tailored RTW-solutions. Work-focused therapy Because of the limited impact of regular MHC on RTW we developed a new intervention provided by psychotherapists: work-focused cognitive behavioural therapy (W-CBT). W-CBT uses work as an early and integral part of clinical treatment, following a graded exposure perspective. This intervention was compared with regular CBT among 168 employees on sick leave with CMD (major depression was excluded). W-CBT showed to be a (cost) effective method to promote faster RTW (65 days earlier), without negative side effects on recovery of CMD symptoms and irrespective of baseline symptom severity. Low self-efficacious employees who received W-CBT showed faster partial RTW, but did not benefit from W-CBT in terms of full RTW. Contrary to our expectations the effectiveness of W-CBT on RTW could not be explained by stronger increases of RW-SE in W-CBT. Main challenges regarding RTW interventions for workers with CMD are to unravel mediating factors or effective intervention elements and tailor RTW interventions to the needs of low self-efficacious and major depressed workers.Although enhancing RTW-SE is important for RTW, W-CBT must have affected other factors besides RTW-SE that further enhanced RTW chances. Future research may test our hypothesis that the effectiveness of W-CBT may be related to the therapeutic conditions that stimulated optimal creation and implementation of tailored gradual RTW plans. To conclude, this dissertation has provided valuable insights in the RTW process and practical tools that may be used to enhance the effectiveness of RTW interventions for workers with CMD. |
