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In many industrialised countries, the high prevalence and/or increasing trends in disability and work loss due to depressive disorders are worrying. For example, in Finland almost one in every three new work disability benefit recipients is disabled for work because of mental health problems.1 A common disorder such as depression, with a lifetime prevalence of up to 25% for women and 12% for men,2 would justify primary prevention programmes. Although such programmes have proven helpful for some conditions such as cardiovascular diseases, evidence for primary prevention of depression is limited, although many of the risk factors for depression have been identified as modifiable.3 While this lack of evidence is not a sufficient reason to abandon well-designed primary prevention programmes, it does provide health professionals and authorities with an incentive to focus preventive efforts on disability due to major depressive disorder through secondary prevention strategies.
In recent years, there has been considerable interest in the evaluation of the potential benefits from secondary prevention of work disability. Since the 1990s, many innovative rehabilitation programmes for sick-listed employees have been developed. The so-called Sherbrooke model, which aims at an early return to work (RTW) through integration of the workplace in the treatment programme, was first applied to low back pain.4 Evidence now indicates that this type of workplace-based intervention is more effective than usual healthcare interventions for reducing sick leave and preventing work disability among employees with musculoskeletal disorders.5
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