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多学科健康评估对精神疾病患者就业的影响——一项准随机对照试验。

Employment effects of a multidisciplinary health assessment for mentally ill persons - A quasi-randomised controlled trial.

机构信息

1 The Danish Working Environment Authority, Denmark.

2 Mental Health Centre Copenhagen, Denmark.

出版信息

Scand J Public Health. 2018 May;46(3):389-399. doi: 10.1177/1403494817723458. Epub 2017 Aug 28.

Abstract

AIM

Relatively little is known about the effectiveness of return-to-work interventions for employees sick-listed with mental disorders, and the results of the literature are contradictory. This study evaluated the return-to-work effect of a multidisciplinary health assessment for persons sick-listed with mental disorders.

METHODS

The study population consisted of 244 persons who were allocated to the treatment and control groups based on their birth year. In addition to the usual case management, the treatment group ( n = 83) was assessed by a team consisting of a case manager, a psychiatrist, and a job coach. The control group ( n = 99) received the usual case management. We used unique register data to code outcome variables (sick-leave duration and return-to-work duration).

RESULTS

The multidisciplinary treatment had no statistically significant effect on the sick-leave duration (HR = 1.05; 95% CI 0.74-1.43) or the return-to-work duration (HR = 0.94; 95% CI 0.65-1.35). Subgroup analyses showed that the treatment effect did not systematically depend on age, education or severity of the mental disorder. We found no signs of systematic dropout from the study population or of imbalanced data. We found an insignificant tendency indicating that control-group case managers may have learned about the intervention from treatment case managers ( p = 0.31).

CONCLUSIONS

This study showed no return-to-work effect of a multidisciplinary assessment of sick-listed individuals with mental disorders. Together with the sparse and inconclusive findings of the literature, this finding suggests that further research is needed for disentangling the elements that constitute an effective intervention.

摘要

目的

对于因精神障碍而请病假的员工,重返工作岗位的干预措施的效果知之甚少,而且文献结果相互矛盾。本研究评估了针对精神障碍请病假者进行多学科健康评估的重返工作岗位效果。

方法

研究人群由 244 人组成,他们根据出生年份被分配到治疗组和对照组。除了常规的病例管理外,治疗组(n=83)由一名病例经理、一名精神科医生和一名工作指导员组成的团队进行评估。对照组(n=99)接受常规的病例管理。我们使用独特的登记数据对结果变量(病假持续时间和重返工作时间)进行编码。

结果

多学科治疗对病假持续时间(HR=1.05;95%CI 0.74-1.43)或重返工作时间(HR=0.94;95%CI 0.65-1.35)没有统计学上的显著影响。亚组分析表明,治疗效果并不系统地依赖于年龄、教育程度或精神障碍的严重程度。我们没有发现研究人群系统退出或数据不平衡的迹象。我们发现了一个无意义的趋势,表明对照组的病例经理可能从治疗组的病例经理那里了解到了干预措施(p=0.31)。

结论

本研究未显示多学科评估对精神障碍请病假者的重返工作岗位有效果。这一发现与文献中稀疏和不确定的结果一起表明,需要进一步研究以厘清构成有效干预措施的要素。

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