常见精神障碍患者治疗后恢复工作的预测因素：一项前后对照研究。
Predictors of return to work among patients in treatment for common mental disorders: a pre-post study.
作者信息
Victor Mattias, Lau Bjørn, Ruud Torleif
机构信息
Lovisenberg Hospital, Postboks 4970, Nydalen, 0440, Oslo, Norway.
University of Oslo, Institute of Clinical Medicine, Oslo, Norway.
出版信息
BMC Public Health. 2017 Jul 18;18(1):27. doi: 10.1186/s12889-017-4581-4.
BACKGROUND
Effects of return to work (RTW) interventions vary, and more knowledge is needed about the factors that contribute to RTW. This study investigated changes in work participation and mental health, and predictors of RTW among patients being treated for common mental disorders (CMDs).
METHODS
The study was a prospective pre-post study of 164 patients treated at an RTW outpatient clinic for CMDs. Differences between before and after treatment were analysed using paired t tests for continuous variables and marginal homogeneity test for categorical variables. Univariable and multivariable logistic regression analyses were used to identify factors associated with RTW. Baseline data (patient characteristics, clinical status, generalized self-efficacy, expectations of future work ability) and treatment variables were used as independent variables in logistic regressions. Further analysis investigated whether improvements in symptoms, work ability, expectations of future work ability and generalized self-efficacy were associated with RTW.
RESULTS
Number of individuals with full work participation increased, and there were improvements in symptoms, work ability and generalized self-efficacy. In the final model for predicting RTW, baseline work ability and expectancy of future work ability, a history of psychiatric treatment and focus on RTW in the treatment predicted RTW. Improvement in expectations of future work ability at post-treatment did also predict RTW.
CONCLUSIONS
Assessing work ability and expectations of RTW at the beginning of treatment is recommended to identify patients at risk of long-term sick leave. Individuals with a history of psychiatric treatment are also risking long-term work disability. It is essential that treatment focus not only on symptom-relief, but also on improving work ability and expectations of RTW. An RTW-focused approach in therapy is associated with RTW.
TRAIL REGISTRATION
ClinicalTrails.gov ID NCT01181635 . Registered 08/12/2010.
背景
重返工作岗位（RTW）干预措施的效果各不相同，对于促成RTW的因素还需要更多了解。本研究调查了常见精神障碍（CMD）患者的工作参与度和心理健康变化，以及RTW的预测因素。
方法
本研究是一项对164名在RTW门诊接受CMD治疗的患者进行的前瞻性前后对照研究。使用配对t检验分析连续变量治疗前后的差异，使用边际同质性检验分析分类变量的差异。采用单变量和多变量逻辑回归分析来确定与RTW相关的因素。基线数据（患者特征、临床状况、一般自我效能感、对未来工作能力的期望）和治疗变量用作逻辑回归中的自变量。进一步分析调查症状、工作能力、对未来工作能力的期望和一般自我效能感的改善是否与RTW相关。
结果
完全参与工作的个体数量增加，症状、工作能力和一般自我效能感均有所改善。在预测RTW的最终模型中，基线工作能力和对未来工作能力的期望、精神治疗史以及治疗中对RTW的关注可预测RTW。治疗后对未来工作能力期望的改善也可预测RTW。
结论
建议在治疗开始时评估工作能力和对RTW的期望，以识别有长期病假风险的患者。有精神治疗史的个体也有长期工作残疾的风险。至关重要的是，治疗不仅要关注症状缓解，还要注重提高工作能力和对RTW的期望。治疗中以RTW为重点的方法与RTW相关。
试验注册
ClinicalTrails.gov标识符NCT01181635。于2010年12月8日注册。
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