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Studies in occupational epidemiology and the risk of overadjustment
  1. E M de Croon
  1. Correspondence to:
 Dr E M de Croon
 Coronel Institute for Occupational Health, Academic Medical Center, PO Box 227700, 1100 DE Amsterdam, Netherlands; e.m.decroon{at}

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Commentary on the paper by Lötters et al (see page 794)

Lötters and colleagues’ study1 about return to work in musculoskeletal disorders is important for three reasons. First, it deals with a type of disorder that is widespread and costly in terms of increased sickness absence and healthcare use.2,3 Second, it recognises return to work as a biopsychosocial phenomenon that is influenced by medical, environmental, and personal factors. Third, it uses a strong prospective cohort design to examine the effect of depressive symptoms, fear-avoidance, and self-efficacy on return to work.

The study shows that in employees with musculoskeletal disorders, depressive symptoms play a central role in the return-to-work process. Interestingly, this finding is compatible with return-to-work research among workers with other prevalent disorders such as common mental disorders …

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  • Competing interests: none declared

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