Efficacy and cost-effectiveness of Acceptance and Commitment Therapy and a Workplace Intervention for workers on sickness absence due to mental disorders. Anna Finnes Psychologist, PhD student Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

Anna Finnes2 Sickness absence due to mental disorders  Mental disorders are among the leading causes of disability  Especially among people in working ages  Most common diagnosis  Adjustment disorders  Depression  Long sickness absence spells

Treatment options?  Cognitive behavioral Therapy (CBT)  Not effective with regard to sickness absence/RTW  Acceptance and Commitment Therapy (ACT)  Third wave behavior therapy  Seeks the construction of broad, flexible behavior repertoires  Workplace interventions (WI)  Moderate quality evidence (Cochrane, 2009) for muskuloskeletal pain  No evidence for mental disorders  Combining clinical interventions with workplace interventions  Reduce both clinical symptoms and sickness absence? Anna Finnes3

Efficacy of Acceptance and Commitment Therapy and a Workplace oriented intervention on RTW  The overall objective of the present study was to evaluate the efficacy of ACT and a WI, separately and in combination, in comparison to TAU.  RCT Anna Finnes4

Anna Finnes5 Study design Waiting-list control ABC program Recruitment ACT Treatment 3 months WI Post-measurement ACT+WITAU Assessment Randomization (n=352) Follow-up measurement (3 months) Follow-up measurement (9 months) Follow-up measurement (21 months) Pre-measurement

Acceptance and Commitment Therapy ACT  6 sessions (60 min)  Treatment manual  Case conceptualization  Acceptance and mindfulness skills training  Clarification of personal values and life goals  Behaviour activation  Between sessions tasks  Reading material  Exercises Anna Finnes6

Workplace Dialogue Intervention (Karlsson et al, 2010) Causes at work and outside work? What has been done? Own suggestions? Employers efforts? 1.Interview client 2. Interview supervisor Summary Solutions Suggested changes Initiate dialogue 3. Convergence dialogue meeting 7

Results Descriptive data (n=352) Mean age: 47.6 (SD=8.84) Range % women 60% finished university degree Compensated sickness absence days past 24 months: m=126.7 (SD=97.4)  Diagnostic groups: 8

Net Sickness absence days  PRE - POST  No overall difference between groups over time F(3,1720)=1.272, p=.282)  All groups improved over time F(1,1720)=43.285, p<.001)  No differences between groups F(3,1720)=.273, p=.845)  Follow-up  No interaction effect  All groups improved over time  No differences between groups  None of the intervention groups outperformed TAU Anna Finnes9

Symptoms  PRE to POST  Symptoms of exhaustion (KEDS) (p=.03)  ACT (b = -3.51, p=.003, d=.49)  ACT+WDI (b = -2.38, p=.049, d=.33)  Symptoms of depression (HADS dep) (p =.017)  ACT (b = -1.98, p=.002, d=.55)  ACT+WDI (b = -1.28, p=.045, d=.36  Symptoms of anxiety (HADS anx) (p=.082)  ACT (b = -1.98, p=.019, d=.39)  No differences between groups over time during follow-up Anna Finnes10

Economic evaluation Limited societal perspective Anna Finnes11  Cost-utility analysis  Costs  Effect: QALY EuroQol 5D (EQ-5D)  ICER: the price for one life year in full health gained Costs ACT (n=62)WDI (n=45)ACT+WDI (n=61)TAU (n=62) Intervention Health care Social security Sum:

Economic evaluation Limited societal perspective  Cost-utility analysis Anna Finnes12 Alt. GroupNQALYCostInc. costInc. effectICER A 00 B ACT690, , F ACT+WDI630, , ACT

Anna Finnes13 Thank you for your attention!

Work ability (Work Ability Index)  No significant differences between groups over time  All groups improved over time  None of the intervention groups outperformed TAU Anna Finnes14

Economic evaluation Health care perspective  Cost-utility analysis: cost per QALY Anna Finnes15 Alt. GroupNQALYCostInc. costInc. effectICER A 00 B ACT690, , C ACT+WDI630, , D WDI450, , E TAU650, , ACT ACT+WDI TAU WDI