Supporting return to work after psychiatric hospitalization-A cluster randomized study (RETURN-study)

Abstract

Background: If people with episodic mental-health conditions lose their job due to an episode of their mental illness, they often experience personal negative consequences. Therefore, reintegration after sickness leave is critical to avoid unfavourable courses of disease, longer inability to work, long payment of sickness benefits and unemployment. Existing return-to-work (RTW) programs have mainly focussed on "common mental disorders" and often used very elaborate and costly interventions without yielding convincing effects. It was the aim of the RETURN-study to evaluate an easy-to-implement RTW-intervention specifically addressing persons with mental illnesses being so severe that they require inpatient treatment. Methods: The RETURN-study was a multi-center, cluster-randomized controlled trial in acute psychiatric wards addressing inpatients suffering from a psychiatric disorder. In intervention wards case-managers (RTW-experts) were introduced who supported patients in their RTW-process, while in control wards treatment as usual was continued. Results: N=268 patients were recruited for the trial. Patients in the intervention group had more often returned to their workplace at 6 months and at 12 months, which was also mirrored in more days at work. These group differences were statistically significant at 6 months. However, for the main outcome (days at work at 12 months), differences were no longer statistically significant (p=0.14). Intervention patients returned to their workplace earlier than patients in the control group (p=0.040). Conclusions: The RETURN-intervention has shown the potential of case-management interventions when addressing RTW. Further analyses, especially the qualitative ones, may help to better understand limitations and potential areas for improvement.