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Original Article
Effect on return to work or education of Individual Placement and Support modified for people with mood and anxiety disorders: results of a randomised clinical trial
  1. Lone Hellström1,
  2. Per Bech2,
  3. Carsten Hjorthøj1,
  4. Merete Nordentoft1,
  5. Jane Lindschou3,
  6. Lene Falgaard Eplov1
  1. 1Copenhagen University Hospital, Mental Health Center Copenhagen, Hellerup, Denmark
  2. 2Psychiatric Research Unit, Mental Health Centre North Zealand, University of Copenhagen, Hellerup, Denmark
  3. 3Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen, Denmark
  1. Correspondence to Lone Hellström, Copenhagen University Hospital, Research Unit, Mental Health Center Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Denmark; lone.hellstroem{at}regionh.dk

Abstract

Objectives The effect of Individual Placement and Support (IPS) on return to work or education among people with mood or anxiety disorders is unclear, while IPS increases return to work for people with severe mental illness. We examined the effect of IPS modified for people with mood and anxiety disorders (IPS-MA) on return to work and education compared with services as usual (SAU).

Methods In a randomised clinical superiority trial, 326 participants with mood and anxiety disorders were centrally randomised to IPS-MA, consisting of individual mentor support and career counselling (n=162) or SAU (n=164). The primary outcome was competitive employment or education at 24 months, while weeks of competitive employment or education, illness symptoms and level of functioning, and well-being were secondary outcomes.

Results After 24 months, 44.4% (72/162) of the participants receiving IPS-MA had returned to work or education compared with 37.8% (62/164) following SAU (OR=1.34, 95% CI: 0.86 to 2.10, p=0.20). We found no difference in mean number of weeks in employment or education (IPS-MA 32.4 weeks vs SAU 26.7 weeks, p=0.14), level of depression (Hamilton Depression 6-Item Scale score IPS-MA 5.7 points vs SAU 5.0 points, p=0.12), level of anxiety (Hamilton Anxiety 6-Item Scale score IPS-MA 5.8 points vs SAU 5.1 points, p=0.17), level of functioning (Global Assessment of Functioning IPS-MA 59.1 points vs SAU 59.5 points, p=0.81) or well-being measured by WHO-Five Well-being Index (IPS-MA 49.6 points vs SAU 48.5 points, p=0.83) at 24 months.

Conclusion The modified version of IPS, IPS-MA, was not superior to SAU in supporting people with mood or anxiety disorders in return to work at 24 months.

Trial registration number NCT01721824.

  • Supported employment
  • affective disorder
  • anxiety

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Footnotes

  • Contributors LH participated in the planning and design of the trial and conducted the research interviews, data analysis and interpretation, drafting of the figures and writing of the manuscript. LFE conceived the trial and participated in the planning and design, data interpretation and co-writing of the manuscript. MN participated in the planning and design of the trial and in data interpretation. JL participated in the design of the trial and in the planning of analysis. PB participated in the planning and design of the trial and was responsible of the training of the assessors. CH took part in the data preparation, analysis and interpretation of data. All authors have read and critically revised the manuscript.

  • Funding The trial as a whole is funded by the Obel Family Foundation, the Tryg Foundation and the Danish Agency for Labour Market and Recruitment. No current or future sponsors of the trial will have any role in the trial design, collection of data, analysis of data, data interpretation or publication of data from the trial.

  • Competing interests Managerial responsibility and supervision lie with LFE, MN and PB. Sherpa has had no role in the trial design, collection, analysis or interpretation of data nor in publication of data from the trial. Due to administrative convenience, LH was formally employed by Sherpa from 1 June 2011 until 31 August 2013. LH’s PhD has exclusively been funded by external funding, and LH has throughout the entire period been working at the Research Unit at Mental Health Centre Copenhagen, where she is now employed. None of the other authors has any competing interest.

  • Ethics approval The Regional Ethics Committees of the Capital Region (journal no: H-2-2011-FSP20).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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