Sickness absence due to common mental disorders (CMD), such as depression, anxiety disorder and adjustment disorder, is a problem in many Western countries, including Sweden, Germany, the UK and the Netherlands . Moreover, CMD have negative consequences for the worker. They affect functioning in private life and can lead to long-term absenteeism, which is associated with individual suffering, reduced probability of eventual return-to-work (RTW), a weakened financial position, social isolation, and exclusion from the labour market [2, 3]. Only 50% of the workers sick listed for 6 months or more return to their work . In workers with CMD, sickness absence costs are reported to be much higher than the medical costs, mainly due to the long duration of a sick leave period [5, 6]. In addition, (long-term) sickness absence leads to substantial social and financial costs for society . In the Netherlands, about one third of people receiving disability benefits do so because of mental health problems [7, 8] of which most are CMD . The annual costs of sickness absence due to CMD are estimated at 2.7–7.5 billion euros [6, 9].
In 2000, the Netherlands Society of Occupational Medicine (NVAB) developed a practice guideline entitled ‘The management of mental health problems of workers by occupational physicians’ and revised it in 2007 [10, 11]. This guideline, which is both practice and evidence-based, promotes an activating approach by the occupational physician (OP) aimed to establish faster RTW by enhancing the problem-solving capacity of workers, especially in relation to their work environment . The guideline was disseminated among Dutch occupational health services (OHS) and OPs. In addition, educational meetings were organised (nationally and locally) for OPs to increase their knowledge on the guideline content. The OPs themselves and the OHS are expected to obtain the required skills to perform in accordance with the guideline. However, a retrospective study showed that the quality of the occupational care provided did not fully meet the requirements of the guideline, and that in workers with adjustment disorders closer adherence to this guideline was associated with a shortened sick leave duration . Another Dutch study provided OPs with a three-day training in guideline use; results showed that, although their compliance was minimal, OPs had a positive attitude towards using the guideline [6, 13]. Therefore, present study investigates whether guideline adherence leads to faster and sustainable RTW of workers with CMD.
Aim of this study
To evaluate the effect of guideline-based care by OPs on the full RTW of workers sick listed due to CMD.