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Long-term effects on income and sickness benefits after work-focused cognitive-behavioural therapy and individual job support: a pragmatic, multicentre, randomised controlled trial
  1. Simon Øverland1,2,
  2. Astrid Louise Grasdal3,
  3. Silje Endresen Reme4,5
  1. 1 Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
  2. 2 Department of Psychosocial Science, University of Bergen, Bergen, Norway
  3. 3 Department of Economics, University of Bergen, Bergen, Norway
  4. 4 Uni Research Health, Uni Research, Bergen, Norway
  5. 5 Department of Psychology, University of Oslo, Oslo, Norway
  1. Correspondence to Professor Simon Øverland, Division of mental and physical health, Norwegian Institute of Public Health, Bergen 5808, Norway; simon.overland{at}


Background There is moderate quality evidence that integrating work-directed interventions and components from psychological therapies reduces sickness absence in the medium term. We aimed to extend this evidence by examining objectively ascertained income and work participation status up to 4 years after an intervention to improve outcomes among people who struggle with work from common mental disorder.

Methods The intervention combined components from cognitive behavioural therapy with principles from supported employment, and compared its efficacy with usual care. Outcomes were derived from registry data with no attrition, in a pragmatic multisite randomised controlled trial (N=1193).

Results The intervention group had higher income, higher work participation and more months without receiving benefits over the 10-month to 46-month long-term follow-up period after end of treatment, but differences were not statistically significant. For the group on long-term benefits at inclusion, effect sizes were larger and statistically significant.

Conclusion There were no statistically significant differences between the two groups in the primary outcome in the total population. In a secondary analysis for the subgroup most at risk of permanent work exclusion, long-term outcomes were favourable in the intervention group compared with usual care. The results support integrated work and health services for people on the severe end of work participation challenges.

Trial registration number NCT01146730.

  • work-focused CBT
  • supported employment
  • mental health
  • work disability
  • sickness absence

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  • Contributors SNØ drafted the paper and led the process. ALG carried out the data analysis. SER was the principal investigator. All authors were involved in the AWaC trial from initiation to completion. All authors collaborated with the design and performed the current paper, the data analyses, interpretation of results and manuscript write-up. All authors read and approved of the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The Norwegian Regional Ethical Committee approved the study (reference number: 2010/1130).

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

  • Data sharing statement The permission to use registry data restricts data sharing beyond published results.