Problem-Based Self-care Groups Versus Cognitive Behavioural Therapy for Persons on Sick Leave Due to Common Mental Disorders: A Randomised Controlled Study
- 509 Downloads
Purpose To evaluate the interventional capacity of problem based method groups (PBM) regarding mental health and work ability compared to cognitive behavioural therapy (CBT) for persons on sick leave due to common mental disorders. Methods In a randomised controlled design the experimental group received PBM and the control group received CBT. Outcomes were measured by the Hospital Anxiety and Depression Scale (HADS), the Stress and Crisis Inventory 93 (SCI-93) and the Dialogue about Working Ability instrument (DOA). Results Twenty-two participants in the PBM group and 28 in the CBT group completed intervention. Both groups showed significant lower scores on the two HADS subscales. Regarding stress the PBM group showed significant decrease in one (out of three) subscales of SCI-93. The CBT group showed significant decrease on all subscales of SCI-93. Regarding work ability the PBM group showed significant higher scores on one of five subscales of DOA. The CBT group showed significant higher scores on four of five subscales of DOA. Between groups there were significant differences to the favour of CBT on one of two subscales of HADS, all three subscales of SCI-93 and on two of the five subscales of DOA. Conclusion PBM seem to be able to reduce anxiety- and depression symptoms. CBT showed to be superior to PBM in reducing symptoms in all aspects of mental health, except for anxiety, in which they seem equally effective. Regarding work ability CBT showed to be superior, with significant effect on more aspects compared to PBM.
KeywordsAnxiety Depression Intervention Primary health care Return to work Sickness absence Stress
This project was financed by the REHSAM-programme (the Swedish Social Insurance Agency and the Vårdal Foundation), FORSS (the Medical Research Council of Southeast Sweden) and the County Councils in Jönköping and Kalmar, Sweden. We gratefully acknowledge all participants, group leaders, therapists and Susanne Ekdahl, Nyckeln Competence Centre for Pedagogics in Healthcare, Kalmar County Hospital, as well as the project group and all other health care professionals who contributed to this project.
Conflict of interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
- 1.Försäkringskassan [The Swedish Social Insurance Agency]. Socialförsäkringen i siffror 2012 [Social Insurance in figures 2012] (in Swedish). Stockholm: 2012 [cited 2013 Sept 02]. http://www.forsakringskassan.se/irj/go/km/docs/fk_publishing/Dokument/Publikationer/Socialforsakingen.
- 2.Organisation for Economic Co-operation and Development. Sick on the job?: Myths and realities about mental health and work. Paris: OECD Publishing; 2012.Google Scholar
- 5.Försäkringskassan [The Swedish Social Insurance Agency]. Sjukskrivning och sjukpenning [Sick leave and sickness benefits] (in Swedish) [cited 2013 Sept 02]. http://www.forsakringskassan.se/sjukvard/sjukskrivning_och_sjukpenning.
- 6.Kielhofner G. A model of human occupation: theory and application. Baltimore: Williams & Wilkins; 2008.Google Scholar
- 7.Wilcock A. An occupational perspective of health. Thorofare: Slack; 2006.Google Scholar
- 8.Jensen I, Busch H. English summary of the national evaluation of the Rehabilitation Guarantee. Karolinska Institutet; 2011 [cited 2013 Sept 02]. http://ki.se/.
- 9.Sveriges kommuner och landsting [Swedish Association of Local Authorities and Regions]. Rehabiliteringsgarantin – utveckling och planering i landstingen [The Rehabilitation Guarantee—development and planning in the counties] (in Swedish). Stockholm: SKL; 2011.Google Scholar
- 10.World Health Organisation. International classification of diseases. ICD-10 version: 2010 [cited 2013 Sept 02]. http://www.who.int/classifications/icd/en/.
- 11.World Health Organisation. International classification of functioning, disability and health (ICF) [cited 2013 Aug 30]. http://www.who.int/classifications/icf/en/.
- 12.Socialstyrelsen [The National Board of Health and Welfare]. Nationella riktlinjer för vård vid depression och ångestsyndrom 2010– stöd för styrning och ledning [National guidelines for treatment of depression and anxiety syndromes 2010-support for guiding and direction] (in Swedish) [cited 2013 Sept 03]. http://www.socialstyrelsen.se/lists/artikelkatalog/attachments/17948/2010-3-4.pdf.
- 15.Passer MW, Smith RE. Psychology. The science of mind and behaviour. 2nd ed. New York: McGraw-Hill; 2004.Google Scholar
- 16.Weissman MM, Markowitz JC, Klerman GL. Comprehensive guide to interpersonal psychotherapy. New York: BasicBooks; 2000.Google Scholar
- 22.Kärner A, Nilsson S, Jaarsma T, Andersson A, Wiréhn A-B, Wodlin P, et al. The effect of problem-based learning in patient education after an event of coronary heart disease—a randomised study in primary health care: design, methodology of the COR-PRIM study. BMC Fam Pract. 2012;13:110.CrossRefPubMedCentralPubMedGoogle Scholar
- 28.Försäkringskassan [The Swedish Social Insurance Agency] Sjukvård/REHSAM [Healthcare/REHSAM] (in Swedish) [cited 2014 Apr 22] https://www.forsakringskassan.se/sjukvard/REHSAM.
- 29.SCB [Statistics Sweden]. Länens arbetsmarknad– befolkning, näringsliv, yrken och framtida pensionsavgångar [The labour market in the counties—population, economy, professions and future retirements] (in Swedish) [cited 2013 Aug 23] http://www.scb.se/statistik/_publikationer/UF0521_2007A01_BR_AM78BR1001.pdf.
- 30.World Medical Association. World medical association declaration of Helsinki—Ethical principles for medical research involving human subjects 1964 [cited 2014 Jan 02]. http://www.wma.net/en/10home/index.html.
- 33.Saboonchi F, Wennman-Larsen A, Alexanderson K, Petersson L-M. Examination of the construct validity of the Swedish version of Hospital Anxiety and Depression Scale in breast cancer patients. Qual Life Res. 2013;22(10):2849–56.Google Scholar
- 34.Nyström C, Nyström O. Skattad stress verifierar autonom dysfunktion [Assessed stress verifies autonom dysfunction]. Läkartidningen 1996; 93(28–29):2583–84 (in Swedish).Google Scholar
- 35.Krafft B, Nyström C. Hög stressnivå och omogna försvar ger ond cirkel vid långvarig smärta [High stress levels and immature ego defences lead to a vicious circle in pain]. Läkartidningen. 2002; 99(41):4040–43 (in Swedish).Google Scholar
- 36.Linddahl I. Validity and reliability of the instrument DOA; a dialogue about working ability [dissertation]. Jönköping: Hälsohögskolan; 2007.Google Scholar
- 39.Altman DG. Practical statistics for medical research. London: Chapman and Hall; 1991.Google Scholar
- 52.Smith E, Comyn P. The development of employability skills in novice workers. National Centre for Vocational Education Research (NCVER); 2003.Google Scholar
- 53.Biesma RG, Pavlova M, Vaatstra R, van Merode GG, Czabanowska K, Smith T, et al. Generic versus specific competencies of entry-level public health graduates: employers’ perceptions in Poland, the UK, and the Netherlands. Adv Health Sci Educ Theory Pract. 2008;13(3):325–43.CrossRefPubMedGoogle Scholar
- 54.Lynøe N, Wessel M, Olsson D, Alexanderson K, Tännsjö T, Juth N. Duelling with doctors, restoring honour and avoiding shame? A cross-sectional study of sick-listed patients’ experiences of negative healthcare encounters with special reference to feeling wronged and shame. J Med Ethics. 2013;39:654–7.CrossRefPubMedGoogle Scholar
- 65.Wells A. Emotional disorders and metacognition: innovative cognitive therapy. Chichester: Wiley; 2000.Google Scholar
- 69.Blades D. Women and men in OECD countries. Paris: Organisation for Economic Co-operation and Development (OECD); 2007 [cited 2013 Sept 11]. http://www.oecd.org/dataoecd/44/52/37962502.pdf.
- 72.Sveriges kommuner och landsting [Swedish Association of Local Authorities and Regions]. Rehabiliteringsgarantin 2011 – Resultat 2011 [The rehabilitation guarantee 2011—results 2011] (in Swedish). Stockholm: SKL; 2012.Google Scholar