Ketelaar Sarah M, Nieuwenhuijsen Karen, Gärtner Fania R, Bolier Linda, Smeets Odile, Sluiter Judith K
Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands,
Int Arch Occup Environ Health. 2014 Jul;87(5):527-38. doi: 10.1007/s00420-013-0893-6. Epub 2013 Jul 28.
The aim of this study was to compare two approaches for a worker's health surveillance (WHS) mental module on work functioning and work-related mental health.
Nurses and allied health professionals from one organisation were cluster-randomised at ward level to e-mental health care (EMH) (N = 579) or occupational physician care (OP) (N = 591). Both groups received screening and personalised feedback on impaired work functioning and mental health. Positively screened participants received an invitation to follow a self-help EMH intervention, or for a consultation with an OP. The primary outcome was impaired work functioning. Follow-up was performed after 3 and 6 months. Linear mixed models were applied to determine differences. Non-inferiority of the EMH-care approach was demonstrated if the mean absolute improvement on work functioning in the OP-care group was ≤10 points higher than the EMH-care group.
Analyses were performed on the positively screened participants (almost 80 %) (EMH N = 75; OP N = 108) and all participants (EMH N = 98; OP N = 142). Both groups improved over time regarding impaired work functioning. A considerable percentage of participants had improved relevantly at follow-up regarding work functioning (3 months: EMH 30 %, OP 46 %; 6 months: EMH 36 %, OP 41 %) compared to baseline. No statistically significant differences were found between the groups, and the difference did not exceed the pre-defined criterion for non-inferiority.
The OP-care approach for a WHS mental module trended towards better performance in targeting work functioning, but our findings indicate that the EMH-care approach was non-inferior. However, the high dropout rate and low compliance to EMH interventions should be taken into account.
本研究旨在比较两种针对劳动者健康监测(WHS)心理模块中工作功能和与工作相关心理健康的方法。
来自一个组织的护士和专职医疗人员在病房层面进行整群随机分组,分为电子心理健康护理(EMH)组(N = 579)和职业医生护理(OP)组(N = 591)。两组均接受了关于工作功能受损和心理健康的筛查及个性化反馈。筛查呈阳性的参与者被邀请参加自助式电子心理健康干预,或与职业医生进行咨询。主要结局是工作功能受损。在3个月和6个月后进行随访。应用线性混合模型来确定差异。如果OP护理组在工作功能方面的平均绝对改善比EMH护理组高≤10分,则证明EMH护理方法具有非劣效性。
对筛查呈阳性的参与者(近80%)(EMH组N = 75;OP组N = 108)和所有参与者(EMH组N = 98;OP组N = 142)进行了分析。两组在工作功能受损方面均随时间有所改善。与基线相比,相当比例的参与者在随访时工作功能有显著改善(3个月:EMH组30%,OP组46%;6个月:EMH组36%,OP组41%)。两组之间未发现统计学上的显著差异,且该差异未超过预先定义的非劣效性标准。
WHS心理模块的OP护理方法在针对工作功能方面有表现更好的趋势,但我们的研究结果表明EMH护理方法具有非劣效性。然而,应考虑到电子心理健康干预的高退出率和低依从性。