Integrated Mental Healthcare and Vocational Rehabilitation for People on Sick Leave with Anxiety or Depression: 24-Month Follow-up of the Randomized IBBIS Trial.
Andreas Hoff, Rie Mandrup Poulsen, Jonas Peter Fisker and 5 others
PMID 36849841WHAT IT FOUND
For people on sick leave with anxiety or depression, an integrated mental health and vocational rehabilitation program did not improve return-to-work rates or self-reported health at 24 months compared to standard services.
Differences were only seen when compared to a mental-health-only arm, not usual care.
Key findings
01At 24-month follow-up, the integrated intervention did not differ from service as usual on vocational outcomes (time to return to work, proportion in work, weeks in work) or self-reported symptoms and quality of life.
02Compared to the mental healthcare-only group, the integrated group showed borderline significant improvements in weeks in work and time to return to work, but no difference compared to usual care.
03The integration of vocational and healthcare components was only implemented with fair fidelity, and workplace-directed interventions were rarely effectuated.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The integration of services was only implemented with fair fidelity, meaning the 'integrated' intervention may not have been fully delivered as designed. Workplace-directed components, which are often key to successful return-to-work interventions, were rarely effectuated. Researchers were not blinded during the 24-month analysis. The study was conducted in Denmark's specific welfare and healthcare system, which may limit generalizability to other countries. The primary outcome was measured at 12 months; this 24-month report includes secondary and exploratory outcomes.
Declared interests
The study was supported by the Mental Health Services of the Capital Region of Denmark and four municipalities. The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that integrated mental health and vocational rehabilitation is ineffective. The trial failed to fully implement the integration, particularly workplace involvement. The null result compared to usual care may reflect poor delivery of the intervention rather than its lack of potential.