向雇主披露心理健康状况的决策辅助：一项随机对照试验的可行性和结果。

Decision aid on disclosure of mental health status to an employer: feasibility and outcomes of a randomised controlled trial.

机构信息

Claire Henderson, PhD, MRCPsych, Elaine Brohan, PhD, Sarah Clement, PhD, Cpsychol, Paul Williams, MSc, Francesca Lassman, MSc, Oliver Schauman, MSc, Lisa Dockery, MSc, Simone Farrelly, PhD, Joanna Murray, BA, Health Service and Population Research Department, Institute of Psychiatry, King's College London; Caroline Murphy, DipHE Nursing (Adult), MSc Clinical Trials, KCTU, Department of Biostatistics, Institute of Psychiatry, King's College London; Mike Slade, PhD, PsychD, Graham Thornicroft, PhD, FRCPsych, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK.

出版信息

Br J Psychiatry. 2013 Nov;203(5):350-7. doi: 10.1192/bjp.bp.113.128470. Epub 2013 Sep 26.

DOI:10.1192/bjp.bp.113.128470

PMID:24072755

Abstract

BACKGROUND

Many mental health service users delay or avoid disclosing their condition to employers because of experience, or anticipation, of discrimination. However, non-disclosure precludes the ability to request 'reasonable adjustments'. There have been no intervention studies to support decision-making about disclosure to an employer.

AIMS

To determine whether the decision aid has an effect that is sustained beyond its immediate impact; to determine whether a large-scale trial is feasible; and to optimise the designs of a larger trial and of the decision aid.

METHOD

In this exploratory randomised controlled trial (RCT) in London, participants were randomly assigned to use of a decision aid plus usual care or usual care alone. Follow-up was at 3 months. Primary outcomes were: (a) stage of decision-making; (b) decisional conflict; and (c) employment-related outcomes (trial registration number: NCT01379014).

RESULTS

We recruited 80 participants and interventions were completed for 36 out of 40 in the intervention group; in total 71 participants were followed up. Intention-to-treat analysis showed that reduction in decisional conflict was significantly greater in the intervention group than among controls (mean improvement -22.7 (s.d. = 15.2) v. -11.2 (s.d. = 18.1), P = 0.005). More of the intervention group than controls were in full-time employment at follow-up (P = 0.03).

CONCLUSIONS

The observed reduction in decisional conflict regarding disclosure has a number of potential benefits which next need to be tested in a definitive trial.

摘要

背景

许多心理健康服务使用者由于经验或预期的歧视而延迟或避免向雇主透露自己的病情。然而，不披露会妨碍请求“合理调整”的能力。目前还没有干预研究来支持向雇主披露的决策。

目的

确定决策辅助是否具有持续的效果，而不仅仅是其直接影响；确定大规模试验是否可行；并优化更大规模试验和决策辅助的设计。

方法

在伦敦进行的这项探索性随机对照试验（RCT）中，参与者被随机分配使用决策辅助加常规护理或仅常规护理。随访时间为 3 个月。主要结果是：（a）决策阶段；（b）决策冲突；和（c）与就业相关的结果（试验注册号：NCT01379014）。

结果

我们招募了 80 名参与者，其中 40 名干预组中的 36 名完成了干预措施；共有 71 名参与者接受了随访。意向治疗分析表明，干预组的决策冲突减少明显大于对照组（平均改善-22.7（s.d. = 15.2）比-11.2（s.d. = 18.1），P = 0.005）。随访时，干预组中有更多的人全职就业（P = 0.03）。