ORIGINAL ARTICLE

Reducing long term sickness absence by an activating intervention in adjustment disorders: a cluster randomised controlled design

J J L van der Klink¹, R W B Blonk², A H Schene³ and F J H van Dijk¹

¹ Coronel Institute for Occupational and Environmental Health, Academic Medical Center, AmCOGG, Amsterdam Center for Research in Health and Health Care, University of Amsterdam, Amsterdam, Netherlands
² TNO Work and Employment
³ Department of Psychiatry, Academic Medical Center, AmCOGG, Amsterdam Center for Research in Health and Health Care, University of Amsterdam

Correspondence to:
Correspondence to:
Dr J J L van der Klink, Academic Medical Center, Coronel Institute, PO 22660, 1100 DD Amsterdam, Netherlands;
j.j.vanderklink{at}amc.uva.nl

Aims: To compare an innovative activating intervention with "care as usual" (control group) for the guidance of employees on sickness leave because of an adjustment disorder. It was hypothesised that the intervention would be more effective than care as usual in lowering the intensity of symptoms, increasing psychological resources, and decreasing sickness leave duration.

Methods: A prospective, cluster randomised controlled trial was carried out with 192 patients on first sickness leave for an adjustment disorder. Symptom intensity, sickness duration, and return to work rates were measured at 3 months and 12 months. Analyses were performed on an intention to treat basis.

Results: At 3 months, significantly more patients in the intervention group had returned to work compared with the control group. At 12 months all patients had returned to work, but sickness leave was shorter in the intervention group than in the control group. The recurrence rate was lower in the intervention group. There were no differences between the two study groups with regard to the decrease of symptoms. At baseline, symptom intensity was higher in the patients than in a normal reference population, but decreased over time in a similar manner in both groups to approximately normal levels.

Conclusion: The experimental intervention for adjustment disorders was successful in shortening sick leave duration, mainly by decreasing long term absenteeism.

Keywords: adjustment disorder; long term sickness absence

Abbreviations: 4DSQ, Four-Dimensional Symptom Questionnaire; DWHQ, Dutch Work and Health Questionnaire; OP, occupational physician; SCL-90, Symptom Checklist-90; UCL, Utrecht Coping List

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