The way out of sick leave: are integrated work-focused interventions effective for the treatment of stress-related illness?

Research problem and specific questionsChronic stress-related disorders are common reasons for sick leave in Sweden.

To date, there is no established evidence-based treatment for these disorders, and overall, few treatment models have succeeded in successfully addressing both symptoms and work ability.

The overall purpose of this project is to evaluate such integrated interventions by comparing the effects of work-focused cognitive behavior therapy (WCBT) to usual treatment for patients on sick leave for chronic stress disorders in a randomized controlled multicenter trial.

Specifically, we aim to investigate whether WCBT is more effective in increasing self-assessed work ability and treating symptoms, and is cost-effective, compared to treatment as usual (TAU). Further, we aim to investigate potential moderators and mediators of change in WCBT for chronic stress disorders.

Data and methodThe study is designed as a randomized controlled (RCT) multicenter study carried out at 3-4 primary care centers in the Stockholm region. The study design will follow participants with questionnaires before, during, and until the post-treatment measurement.

Outcome measures are self-assessed work ability, symptoms of physical and mental fatigue and cognitive weariness and days on sick leave. Weekly measures during treatmetn will include measures of potential mechanism variables.

Societal relevance and utilizationStress-related health problems do not only cause a great deal of personal suffering but also incur a sizable social cost.

The project is expected to generate valuable information related to the effects and cost-effectiveness of guideline-based care as well as care enhanced with WCBT as well as general knowledge about treatment components, implementation strategies, and the influence of individual and contextual factors in work-life rehabilitation.

The results can be used in health care and as a basis for companies and organizations that want to improve their routines around employees on sick leave for mental illness.Plan for project realizationA pilot study has already been conducted at a large primary care center in Stockholm.

At least two more primary care centers will be involved with a study coordinator located at each center to ensure the inclusion of patients and measurement procedures.

The project group consists of experts in intervention research, health economics, and statistical modeling which ensures the methodological quality of the project.