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Evidence summaries

Psychological Therapies to Facilitate Return to Work in Adults with Adjustment Disorders

Problem solving therapy may facilitate return to work in patients on sick leave because of adjustment disorder. Level of evidence: "C"

The quality of evidence is downgraded by inconsistency (heterogeneity in co-interventions) and imprecise results (few studies for each comparison).

Summary

A Cochrane review [Abstract]1 included 9 randomized trials with a total of 1546 participants in examining the effects of psychological interventions to return to work. The patients were adults on sick leave because of adjustment disorders (defined by DSM-IV or ICD-10 diagnostic criteria) or similar distress conditions defined by screening instruments excluding other mental disorders. Four studies were performed in occupational health, 2 in primary care practice, and 3 studies in specific Stress Clinics. Patients were on sick leave at the start of the study: the duration varied from approximately 2 months in 4 studies, to 1 year in one study, and the rest were not reported. The psychological therapies examined were either cognitive behavior therapy (CBT) or problem solving therapy (PST), provided individually for the most.

Patients receiving PST or CBT had shorter period to return to work; for CBT the difference was however not statistically significant. There was no difference between PST and CBT (based on 1 study).

OutcomeNumber of trials (participants)Control:Non-guideline based careIntervention:PSTEffect size (95 % CI)
Full return to work2(342)156 and 91 days153 and 67 daysMD -17.73 (-37.35 to 1.90)
Partial return to work1(192)53 days36 daysMD -17.00 (-26.48 to -7.52)
OutcomeNumber of trials (participants)Control:No interventionIntervention:CBTEffect size (95 % CI)
Full return to work1(105)252 days216 daysMD -35.73 (-113.15 to 41.69)
Partial return to work2(159)88 days80 daysMD -8.78 (-23.26 to 5.71)

References

  • Arends I, Bruinvels DJ, Rebergen DS et al. Interventions to facilitate return to work in adults with adjustment disorders. Cochrane Database Syst Rev 2012;12:CD006389. [PubMed]

Primary/Secondary Keywords