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The European Journal of Public Health Advance Access published online on July 12, 2006
The European Journal of Public Health, doi:10.1093/eurpub/ckl099
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© The Author 2006. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Received March 23, 2006
Accepted June 9, 2006

Article

Cost-effectiveness of an activating intervention by social workers for patients with minor mental disorders on sick leave: a randomized controlled trial

Evelien P. M. Brouwers 1, Martine C. de Bruijne 2, Berend Terluin 3, Bea G. Tiemens 4, and Peter F. M. Verhaak 1 *

1 Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands
2 Unit for Health technology Assessment, Institute for Research in Extramural Medicine (EMGO), VU University Medical Center, Amsterdam, The Netherlands
3 Department of General Practice, Institute for Research in Extramural Medicine (EMGO), VU University Medical Centre, Amsterdam, The Netherlands
4 Gelderse Roos Institute for Professionalisation (GRIP), Wolfheze, The Netherlands

* To whom correspondence should be addressed.
Peter F. M. Verhaak, E-mail: p.verhaak{at}nivel.nl


  Abstract

Background: Sickness absence often occurs in patients with emotional distress or minor mental disorders. In several European countries, these patients are over-represented among those receiving illness benefits, and interventions are needed. The aim of this study was to evaluate the cost-effectiveness of an intervention conducted by social workers, designed to reduce sick leave duration in patients absent from work owing to emotional distress or minor mental disorders. Methods: In this Randomized Controlled Trial, patients were recruited by GPs. The intervention group (N = 98) received an activating, structured treatment by social workers, the control group (N = 96) received routine GP care. Sick leave duration, clinical symptoms, and medical consumption (consumption of medical staffs' time as well as consumption of drugs) were measured at baseline and 3, 6, and 18 months later. Results: Neither for sick leave duration nor for clinical improvement over time were significant differences found between the groups. Also the associated costs were not significantly lower in the intervention group. Conclusions: Compared with usual GP care, the activating social work intervention was not superior in reducing sick leave duration, improving clinical symptoms, and decreasing medical consumption. It was also not cost-effective compared with GP routine care in the treatment of minor mental disorders. Therefore, further implementation of the intervention is not justified. Potentially, programmes aimed at reducing sick leave duration in patients with minor mental disorders carried out closer to the workplace (e.g. by occupational physicians) are more successful than programmes in primary care.

Keywords: cost effectiveness; mental disorders; primary care; randomized controlled trial; sick leave.
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