Ingrid M Bakker, Berend Terluin, Harm W J van Marwijk, Daniëlle A W M van der Windt, Frank Rijmen, Willem van Mechelen, Wim A B Stalman
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引用次数: 82
Abstract
Objective: Mental health problems often affect functioning to such an extent that they result in sick leave. The worldwide reported prevalence of mental health problems in the working population is 10%-18%. In developed countries, mental health problems are one of the main grounds for receiving disability benefits. In up to 90% of cases the cause is stress-related, and health-care utilisation is mainly restricted to primary care. The aim of this study was to assess the effectiveness of our Minimal Intervention for Stress-related mental disorders with Sick leave (MISS) in primary care, which is intended to reduce sick leave and prevent chronicity of symptoms.
Setting: Primary health-care practices in the Amsterdam area, The Netherlands.
Participants: A total of 433 patients (MISS n = 227, usual care [UC] n = 206) with sick leave and self-reported elevated level of distress.
Interventions: Forty-six primary care physicians were randomised to either receive training in the MISS or to provide UC. Eligible patients were screened by mail.
Outcome measures: The primary outcome measure was duration of sick leave until lasting full return to work. The secondary outcomes were levels of self-reported distress, depression, anxiety, and somatisation.
Results: No superior effect of the MISS was found on duration of sick leave (hazard ratio 1.06, 95% confidence interval 0.87-1.29) nor on severity of self-reported symptoms.
Conclusions: We found no evidence that the MISS is more effective than UC in our study sample of distressed patients. Continuing research should focus on the potential beneficial effects of the MISS; we need to investigate which elements of the intervention might be useful and which elements should be adjusted to make the MISS effective.
目的:心理健康问题常常影响到身体机能,以至于导致请病假。据报告,全世界工作人口中心理健康问题的流行率为10%-18%。在发达国家,精神健康问题是领取残疾津贴的主要理由之一。在高达90%的病例中,病因与压力有关,保健利用主要限于初级保健。本研究的目的是评估我们对初级保健中病假压力相关精神障碍(MISS)的最小干预措施的有效性,旨在减少病假和预防症状的慢性化。设计:分组随机对照教育试验。背景:荷兰阿姆斯特丹地区的初级保健做法。参与者:共433例患者(MISS n = 227,常规护理[UC] n = 206),病假和自我报告的痛苦水平升高。干预措施:46名初级保健医生被随机分配,要么接受MISS培训,要么提供UC。通过邮件筛选符合条件的患者。结果测量:主要结果测量是病假的持续时间,直到完全恢复工作。次要结果是自我报告的痛苦、抑郁、焦虑和躯体化水平。结果:MISS在病假持续时间(风险比1.06,95%可信区间0.87-1.29)和自我报告症状的严重程度上均未发现显著效果。结论:在我们的研究样本中,我们没有发现MISS比UC更有效的证据。继续的研究应该集中在MISS的潜在有益影响上;我们需要调查干预的哪些因素可能是有用的,哪些因素应该调整以使MISS有效。