The Danish Ibbis Trials for Sickness Absentees with Common Mental Disorders: A Phase 4 Prospective Study Comparing...

Area of Science:

• Occupational Health
• Mental Health Services Research
• Rehabilitation Medicine

Background:

• Integrated vocational rehabilitation and mental healthcare interventions aim to improve vocational outcomes for sickness absentees.
• Previous randomized controlled trials (RCTs) showed mixed results for the novel intervention (INT), with some diagnostic groups experiencing worse outcomes.
• This phase 4 study evaluates the real-world effectiveness of INT in a Danish municipality.

Purpose of the Study:

• To examine the effectiveness of the integrated intervention (INT) in a real-world setting for sickness absentees with depression, anxiety, or adjustment disorder.
• To compare vocational outcomes of individuals receiving INT in a real-world setting versus those who received INT in prior RCTs.
• To assess the primary outcome of return to work within 12 months.

Main Methods:

• A prospective intervention study design was employed in a real-world setting.
• Adult sickness absentees diagnosed with depression, anxiety, or adjustment disorder were allocated to receive INT.
• Vocational outcomes were compared to a matched group from previous RCTs of INT, with return to work at 12 months as the primary outcome.

Main Results:

• The real-world group (n=151) demonstrated significantly poorer vocational outcomes compared to the RCT group (n=302).
• Return to work within 12 months was lower in the real-world group (48.3%) versus the RCT group (64.6%), with an odds ratio of 0.54 (p=0.001).
• Statistically significant poorer outcomes were observed across most vocational measures, including fewer weeks in work and a lower proportion employed at 12 months.

Conclusions:

• The integrated intervention (INT) was less effective in a real-world setting compared to its performance in randomized controlled trials.
• Implementation challenges, potentially greater in less structured real-world settings, may explain the diminished effectiveness.
• The findings suggest that the less favorable outcomes observed in some groups during RCTs might be exacerbated in real-world practice.