Employees on sick leave with common mental health disorders such as depression and anxiety fully returned to work sooner when therapy deals with work-related problems and how to get back on the job, according to new research published by the American Psychological Association.
Employees who received this therapy and returned to work sooner did not suffer adverse effects and showed significant improvement in mental health over the course of one year, according to the article, published online in APA's Journal of Occupational Health Psychology.
"People with depression or anxiety may take a lot of sick leave to address their problems," said the study's lead author, Suzanne Lagerveld, of the Netherlands Organization for Applied Scientific Research (TNO). "However, focusing on how to return to work is not a standard part of therapy. This study shows that integrating return-to-work strategies into therapy leads to less time out of work with little to no compromise in people's psychological well-being over the course of one year."
The study, conducted in the Netherlands, followed 168 employees, of whom 60 percent were women, on sick leave due to psychological problems such as anxiety, adjustment disorder and minor depression. Seventy-nine employees from a variety of jobs received standard, evidence-based cognitive-behavioral therapy, while the rest received cognitive-behavioral therapy that included a focus on work and the process of returning to work.
Cognitive-behavioral therapy is based on the idea that people's thoughts, rather than external factors such as people, situations or events, cause feelings and behaviors. Cognitive-behavioral therapists encourage their clients to change the way they think in order to feel better even if the situation does not change. Behavioral techniques such as gradual exposure to difficult situations are often used within cognitive-behavioral therapy.
In the work-focused group, psychotherapists addressed work issues in an early phase and used work and the workplace as mechanisms or context to improve the client's mental health. For example, therapists consistently explained to their clients how work can offer structure and self-esteem, characteristics beneficial to clients' recovery. They also helped clients draft a detailed, gradual plan for returning to work, focusing on how the client would engage in specific tasks and activities.
Clients in both groups received treatment for about 12 sessions over an average of six months. The researchers checked in with them at three-month intervals for one year, shortly before treatment began.
Those in the work-focused group fully returned to work on average 65 days earlier than the participants in the standard therapy group, and they started a partial return to work 12 days earlier. Those in the work-focused therapy engaged in more steps to fully return to work, gradually increasing their hours and duties. Almost all the participants in the study 99 percent had at least partially returned to work at the one-year follow-up. Most participants resumed work gradually, with only 7 percent going directly from full sick leave to full-time work.
All participants had fewer mental health problems over the course of treatment, no matter which type of therapy they received, with the most dramatic decrease in symptoms occurring in the first few months.
"Being out of work has a direct effect on people's well-being. Those who are unable to participate in work lose a valuable source of social support and interpersonal contacts," said Lagerveld. "They might lose part of their income and consequently tend to develop even more psychological symptoms. We've demonstrated that employees on sick leave with mental disorders can benefit from interventions that enable them to return to work."
The savings to an employer whose employee went back to work earlier was estimated at 20 percent, which amounted to about a $5,275 gain in U.S. dollars per employee, according to the article. This was based solely on wages paid during sick leave and did not include additional costs of productivity loss and hiring replacements.
The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 154,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.
More information: Article: "Work-Focused Treatment of Common Mental Disorders and Return to Work: A Comparative Outcome Study," Suzanne E. Lagerveld, MS, and Roland W. B. Blonk, PhD, TNO Quality of Life/Work & Employment Hoofddorp, The Netherlands; Veerle Brenninkmeijer, PhD, Leoniek Wijngaards-de Meij, PhD, and Wilmar B. Schaufeli, PhD, Utrecht University; Journal of Occupational Health Psychology, online.