Background In Denmark, 50% of those on long-term sick leave are affected by common mental disorders (CMDs), and it has been argued that detection in primary care has been insufficient. The Mental Health Assessment Study (MeHAS) assesses if specialized mental health assessments can enhance return to work for this group. This study aimed to estimate the effect of a specialized mental health assessment for people on sick leave with a mental health disorder, on return to work and mental health care utilization. Methods and findings In this experimental study, sickness absentees were referred from a sick leave benefit management agency. Before intervention allocation, they had already received a standard health assessment in general practice. The intervention group received an additional specialized mental health assessment, while the control group did not. We compared the groups on several vocational outcome measures, the primary being proportion in work after one year. Other outcomes were weeks in work, time to return to work (RTW) and different measures of service utilization. We included 717 in the intervention group and 756 in the control group. On the primary outcome, proportion in work, we observed no differences between the groups at 12 months (53.9% vs. 58.7% in the control group, p = 0.133). Moreover, after one year, the control group showed faster RTW at 12-month follow-up (HR 0.79, p<0.001) and 3.1 more weeks in work (p<0.001). In the intervention group, participants received more hospital-based outpatient mental healthcare. Conclusion Providing a specialized mental health assessment was associated with fewer weeks in work and longer sick leave duration (secondary outcomes), but the proportion in work at 12-month follow-up (primary outcome) did not differ between the groups. The intervention was associated with a higher likelihood of receiving specialized mental healthcare services, perhaps because more needs were met. Given the substantial risk of selection bias, results should be treated with caution.

Introduction: In two randomized controlled trials (RCT) we tested the efficacy of a novel integrated vocational rehabilitation and mental healthcare intervention, coined INT, for sickness absentees with common mental disorders. The aim was to improve vocational outcomes compared to Service As Usual (SAU). Contrary to expectations, the delivered intervention caused worse outcomes within some diagnostic groups and some benefits in others. In this phase 4 study, we examined the effectiveness of the intervention in real-world practice. Method: In this prospective intervention study, we allocated adult sickness absentees with either depression, anxiety, or adjustment disorder to receive INT in a real-world setting in a Danish Municipality. We compared the vocational outcomes of this group to a matched group who received INT as a part of the RCTs, after randomization to the intervention group herein. Primary outcome was return to work at any point within 12 months. Results: In the real-world group, 151 participants received INT during 2019. From the randomized trials, 302 matched participants who received INT between 2016-2018 were included. On the primary outcome - return to work within 12 months - the real- word group fared worse (48.3 vs 64.6 %, OR 0.54 [95%CI: 0.37-0.79], p = 0.001). Across most other vocational outcomes, a similar pattern of statistically significant poorer outcomes in the real-world group was observed: Lower number of weeks in work and lower proportion in work at 12 months (42.3% vs. 58.3% (p = 0.002)). Discussion: The real-word group showed significantly worse vocational outcomes. Like in many other studies of complex interventions, implementation was difficult in the original randomized trials and perhaps even more difficult in the less structured real- world setting. Since the intervention was less effective for some groups compared to SAU in the original trial, this negative effect may be even more pronounced in a real- world setting.

OBJECTIVES: Integrating vocational rehabilitation and mental healthcare has shown effects on vocational outcomes during sick leave with common mental disorders. In a previous paper, we showed that a Danish integrated healthcare and vocational rehabilitation intervention (INT) had a surprisingly negative impact on vocational outcomes compared to service as usual (SAU) at 6- and 12-month follow-up. That was also the case with a mental healthcare intervention (MHC) tested in the same study. This article reports the 24-month follow-up results of that same study. METHOD: A randomized, parallel-group, three-arm, multi-centre superiority trial was conducted to test the effectiveness of INT and MHC compared to SAU. RESULTS: In total, 631 persons were randomized. Contrary to our hypothesis, SAU showed faster return to work than both INT [hazard rate (HR) 1.39, P=0.0027] and MHC (HR 1.30, P=0.013) at 24-month follow-up. Overall, no differences were observed regarding mental health and functional level. Compared to SAU, we observed some health benefits of MHC, but not INT, at 6-month follow-up but not thereafter, and lower rates of employment at all follow-ups. Since implementation problems might explain the results of INT, we cannot conclude that INT is no better that SAU. The MHC intervention was implemented with good fidelity and did not improve return to work. CONCLUSION: This trial does not support the hypothesis that INT lead to faster return to work. However, implementation failure may explain the negative results.

Purpose Knowledge about predictors of return to work (RTW) in people on sick leave with common mental disorders (CMDs) may inform the development of effective vocational rehabilitation interventions for this target group. In this study, we investigated predictors of RTW at 6 and 12 months in people on sick leave with depression, anxiety disorders or stress-related disorders. Methods We have performed a secondary analysis, utilizing data from two RCTs that evaluated the efficacy of an integrated health care and vocational rehabilitation intervention. Data were obtained from mental health assessments, questionnaires and registers. Using Cox regression analysis, the relationship between baseline variables and RTW was analysed at 6 and 12 months after randomization within the group of CMD as a whole and within the subgroups of depression, anxiety and stress-related disorders. Results Symptom burden and employment status at baseline predicted RTW in the CMD group ( n = 1245) and in the three diagnostic subgroups at both time points. RTW self-efficacy predicted RTW in the depression group but not in the anxiety or stress subgroups. Conclusion Many predictors of RTW were similar over time and, to some extent, across the CMD subgroups. Findings highlight the need not only to take health-related and psychological factors into account when developing vocational rehabilitation interventions but also to consider workplace strategies and options for support.

Objective Stress-related disorders are common, associated with substantial individual suffering, and place a large economic burden on society. While treatment appears to be able to reduce symptoms, evidence of interventions to improve vocational outcomes is flimsy. Lack of integration of vocational rehabilitation and healthcare services has been suspected to be a major potential barrier in return-to-work (RTW) processes; therefore, we aimed to test the effectiveness of such integration. Methods We randomized participants who were on sick leave for ≥ 4 weeks with a stress-related disorder. They were allocated to (i) service as usual (SAU), (ii) improved mental healthcare (MHC), or (iii) integrated interventions (INT). The primary outcome was RTW rates measured at 12 months. Secondary outcome were RTW rates measured at 6 months, proportion in work at 12 months, and levels of stress, anxiety, depression, and functioning at 6 months. Results We included 666 participants. On the primary outcome and almost all other vocational outcomes, SAU was superior to both INT and MHC. MHC and INT did not differ on any vocational outcome. On several symptom scales, MHC showed lower values than SAU, whilst INT did not differ from the two other groups. Conclusion Both the INT and the MHC intervention lowered RTW rates compared with SAU, and thereby yielded a worse outcome. However, the MHC group showed a tendency towards having lower symptom levels compared with those in the SAU group; accordingly, the SAU group is not unequivocally superior. MHC and INT showed no general differences.

OBJECTIVE:The aim of this study was to investigate an integrated mental healthcare and vocational rehabilitation intervention to improve and hasten the process of return-to-work of people on sick leave with anxiety and depression.METHODS:In this three-arm, randomised trial, participants were assigned to (1) integrated intervention (INT), (2) improved mental healthcare (MHC) or (3) service as usual (SAU). The primary outcome was time to return-to-work measured at 12-month follow-up. The secondary outcomes were time to return-to-work measured at 6-month follow-up; levels of anxiety, depression, stress symptoms, and social and occupational functioning at 6 months; and return-to-work measured as proportion in work at 12 months.RESULTS:631 individuals were randomised. INT yielded a higher proportion in work compared with both MHC (56.2% vs 43.7%, p=0.012) and SAU (56.2% vs 45%, p=0.029) at 12-month follow-up. We found no differences in return-to-work in terms of sick leave duration at either 6-month or 12-month follow-up, with the latter being the primary outcome. No differences in anxiety, depression or functioning between INT, MHC and SAU were identified, but INT and MHC showed lower scores on Cohen's Perceived Stress Scale compared with SAU at 12-month follow-up.CONCLUSIONS:Although INT did not hasten the process of return-to-work, it yielded better outcome with regard to proportion in work compared with MHC and SAU. The findings suggest that INT compared with SAU is associated with a few, minor health benefits. Overall, INT yielded slightly better vocational and health outcomes, but the clinical significance of the health advantage is questionable.TRIAL REGISTRATION NUMBER:NCT02872051.

Aims: The Dutch Four-Dimensional Symptom Questionnaire (4DSQ) measures distress, depression, anxiety and somatisation, facilitating the distinction between stress-related problems and psychiatric disorder in primary and occupational health care. The aim of the study was to examine the measurement equivalence across the Danish and Dutch 4DSQ. Methods: Danish 4DSQ data were obtained from a cohort of Danish citizens on sick leave for mental-health problems. Dutch 4DSQ data were obtained from a cohort of Dutch employees on sick leave and a cohort of general practice attenders suspected of having mental-health problems. The study samples were matched on age and sex. The 4DSQ scales were assessed for essential unidimensionality using confirmatory factor analysis. Measurement equivalence of the 4DSQ across the groups was assessed using differential item and test functioning (DIF and DTF) analysis. Results: The study groups each consisted of 1363 people (63% female, Mage=42 years). The 4DSQ scales proved essentially unidimensional. DIF was detected in 20 items. In terms of Cohen’s effect size, DIF was mostly small or moderate. In terms of effect size, the mean effect on the scale score (DTF) was negligible. Nevertheless, it is recommended to adjust some of the cut-off points for two Danish 4DSQ scales to retain the meaning of these cut-off points in Dutch respondents. Conclusions: The Danish version of the 4DSQ measures the same constructs as the original Dutch questionnaire. Twenty items functioned differently in Danish respondents than in Dutch respondents, but this had only a small impact on the scale scores.

IntroductionAnxiety and depression are common causes of long-term sick leave. Currently, lack of coordination of the relevant interventions, seems to entail confusion among sick employees, afflicting their recovery and return-to-work (RTW) process. A positive effect of integrating vocational rehabilitation (VR) and mental health care (MHC) is indicated by some studies, but not finally established. The aim of this study is to examine the efficacy of the integrated IBBIS intervention compared to current, non-integrated interventions.MethodsHypotheses: compared to currently provided interventions, providing 1) improved MHC or 2) integrating MHC with VR, can improve RTW.In this 3-armed randomized controlled trial, 611 participants on sick leave were randomized to:1: Treatment as usual (TAU, a heterogenous non-integrated combination of MHC in primary care and VR at municipalities)2: Standard MHC (research project-delivered), and standard VR in municipalities, non-integrated3: The IBBIS intervention: integrated vocational rehabilitation (VR) and mental health care (MHC)Outcomes are time to stable return to work (RTW), at 6- and 12-month follow-up (FU), levels of depression, anxiety, perceived stress, and functional level at 6-month FU.Researchers are per October 2019 still blinded to group allocation – hence group allocation is concealed as X, Y and Z. Results The three groups showed different RTW-patterns and different symptoms levels.After 6 months group Z, compared to group Y, showed 64% faster RTW (p=0.0033), but worse symptom levels. Group Z compared to X, showed tendency to 31% faster RTW (p = 0.072), but no difference in symptoms.After 12 months groups Z and X respectively, compared to group Y, showed 34% faster RTW (p<0.035), and group Z showed worse symptom levels, compared to group Y. All symptom-differences were small compared to the change over time in all groups.DiscussionDifferent interventions yield different RTW rates, with faster RTW concurrent with worse symptom levels. This might be due to a higher symptom rise after fast RTW compared to slow RTW, perhaps because participants in early phases are still sick despite RTW, which is in line with previous studies. Seemingly there might be an inverse relationship between RTW and symptom levels.ConclusionsIntervention composition affects recovery in different and complex and ways, and fast RTW is not consistently associated with better symptom and functional level – under some conditions, seemingly, the opposite is the case. All unblinded results will be presented.Lessons LearnedRTW does not consistently imply lower symptom levels. Group symptom differences were much smaller than the average general change (very low effect sizes) – we speculate a 3-month FU could have been relevant.LimitationsOnly researchers are blinded, but neither participants nor intervention providers ever were, which might produce bias. Difference between the integrated intervention and the other groups were not only integration, but also the content of the VR delivered. In the TAU group we lack information about MHC provided in primary care.Suggestions For Future ResearchUsing mixed methods and more frequent measurements, the interplay between health, interventions and employment could be examined.

The members of the International Network for the Analysis of Intergenerational Relations (Generationes) proudly present the most recent issue of the jointly produced compendium Generations, Intergenerational Relations and Generational Policy. This new version includes 17 languages: English, French, German, Italian, Spanish, Polish, Portuguese, Swedish, Hungarian, Turkish, Romanian, Lithuanian, Slovenian (new), Bosnian (new), Ukrainian (new), Russian (new) and Chinese (new). The layout of the compendium is designed for using it to translate the specific concepts and terminology of research on generations and intergenerational relations from one language into another.

Generationen, Generationenbeziehungen, Generationenpolitik 2. Generations, intergenerational relationships, generational policy Générations, relations intergénérationelles, politiques de générations Generaciones, relaciones intergeneracionales, política generacional Generazioni, relazioni intergenerazionali, politica generazionale Pokolenia, relacje międzypokoleniowe, polityka relacji międzypokoleniowych Gerações, relações intergeracionais, política geracional Nemzedékek, nemzedékek közötti kapcsolatok, nemzedéki politika Generații, Politici generaționale și relații intergeneraționale Generationer, relationer mellan generationer, generationspolicy Kartos, kartų santykiai, kartų politika Kuşaklar, kuşaklararası ilişkiler, kuşak politikası Generacije, medgeneracijski odnosi, medgeneracijska politika Generacije, međugeneracijski odnosi, generacijska politika Покоління (генерації), міжгенераційні відносини, політика міжгенераційних відносин Поколения, межпоколенческие отношения, межпоколенческая политика 代,代际关系,代际政策

Generationen, Generationenbeziehungen, Generationenpolitik 2. Generations, intergenerational relationships, generational policy Générations, relations intergénérationelles, politiques de générations Generaciones, relaciones intergeneracionales, política generacional Generazioni, relazioni intergenerazionali, politica generazionale Pokolenia, relacje międzypokoleniowe, polityka relacji międzypokoleniowych Gerações, relações intergeracionais, política geracional Nemzedékek, nemzedékek közötti kapcsolatok, nemzedéki politika Generații, Politici generaționale și relații intergeneraționale Generationer, relationer mellan generationer, generationspolicy Kartos, kartų santykiai, kartų politika Kuşaklar, kuşaklararası ilişkiler, kuşak politikası Generacije, medgeneracijski odnosi, medgeneracijska politika Generacije, međugeneracijski odnosi, generacijska politika Покоління (генерації), міжгенераційні відносини, політика міжгенераційних відносин Поколения, межпоколенческие отношения, межпоколенческая политика 代,代际关系,代际政策

Common mental disorders are important contributors to the global burden of disease and cause negative effects on both the individual and society. Stress-related disorders influence the individual’s workability and cause early retirement pensions in Denmark. There is no clear evidence that mental health care alone will provide sufficient support for vocational recovery for this group. Integrated vocational and health care services have shown good effects on return to work in other similar welfare contexts.