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Cognitive–behavioural therapy and return-to-work intervention for patients on sick leave due to common mental disorders: a randomised controlled trial
  1. Sigrid Salomonsson1,
  2. Fredrik Santoft1,
  3. Elin Lindsäter1,
  4. Kersti Ejeby2,
  5. Brjánn Ljótsson1,
  6. Lars-Göran Öst1,3,
  7. Martin Ingvar4,5,
  8. Mats Lekander4,5,6,
  9. Erik Hedman-Lagerlöf1,4,5
  1. 1 Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
  2. 2 Department of Neurobiology, Care Sciences and Society (NVS), H1, Division of Family Medicine, Karolinska Institutet, Stockholm, Sweden
  3. 3 Department of Psychology, Stockholm University, Stockholm, Sweden
  4. 4 Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
  5. 5 Department of Neuroradiology, Karolinska University Hospital Stockholm, Stockholm, Sweden
  6. 6 Stress Research Institute, Stockholm University, Stockholm, Sweden
  1. Correspondence to Sigrid Salomonsson, Gustavsberg Primary CareClinic, Odelbergs väg 19, 134 40 Gustavsberg, Sweden; sigrid.salomonsson{at}


Objectives Common mental disorders (CMDs) cause great individual suffering and long-term sick leave. Cognitive–behavioural therapy (CBT) effectively treats CMDs, but sick leave is not reduced to the same extent as psychiatric symptoms. Research results regarding return-to-work interventions (RTW-Is) and their effect on sick leave are inconclusive. The aim of this study was to evaluate CBT, a RTW-I and combined CBT and RTW-I (COMBO) for primary care patients on sick leave due to CMDs.

Methods Patients with CMDs (n=211) were randomised to CBT (n=64), RTW-I (n=67) or COMBO (n=80). Sick-leave registry data after 1 year and blinded Clinician’s Severity Rating (CSR) of symptoms post-treatment and at follow-ups after 6 and 12 months were primary outcomes.

Results There was no significant difference between treatments in days on sick leave 1 year after treatment start (mean difference in sick-leave days range=9–27). CBT led to larger reduction of symptoms post-treatment (CSR; Cohen’s d=0.4 (95% CI 0.1 to 0.8)) than RTW-I, whereas COMBO did not differ from CBT or RTW-I. At follow-up, after 1 year, there was no difference between groups. All treatments were associated with large pre-treatment to post-treatment improvements, and results were maintained at 1-year follow-up.

Conclusion No treatment was superior to the other regarding reducing sick leave. All treatments effectively reduced symptoms, CBT in a faster pace than RTW-I, but at 1-year follow-up, all groups had similar symptom levels. Further research is needed regarding how CBT and RTW-I can be combined more efficiently to produce a larger effect on sick leave while maintaining effective symptom reduction.

  • return-to-work
  • cognitive behavioural therapy
  • common mental disorders

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  • Contributors SS and EH designed the study, developed the treatment, performed the analyses, collected and interpreted the data, and drafted the paper. FS, EL, LGÖ, ML, MI, KE and BL designed the study,developed the treatment, collected and interpreted the data, and drafted the paper.

  • Funding This study was funded by Karolinska Institutet and by research grants from Stockholm County Council. The main funding organisations (Karolinska Institutet and Stockholm County Council) are public institutions and neither of the funding organisations had any role in the design and conduct of the study, in the collection or interpretation of the data, neither in the writing of the report nor in the decision to submit it.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The regional ethics review board in Stockholm.

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