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1 Mental
2 Video conference
3 Program Introduction (David Rebergen, chair) Health management/work Disability Prevention : Assessment by virtual role play E. Pouw : Preventive internet-course stress M. Bool : Internet interventions workplace R. Cook Curative treatments/return to work : Computerized CBT stress P. Grime : Web-based treatment depression D. Rebergen Discussion and Closure
4 Public Defense Amsterdam, July 2nd 2009 David Rebergen, PhD Work and Health psychologist, Epidemiologist, Researcher
5 WHO/EU pact 2009: Mental health and wellbeing at workplace Work is more mental nowadays, with related dysfunctioning and disability. (McDaid, 2008; Black, 2008; Weehuizen, 2008; SER, 2009) Workers ask not only for protection from dangerous work, but seek ways to fulfill life ambitions in work. Legislation has been changing, and will be changed in order to reduce large disability inflow, particularly inflow because of mental disorders. Change from compensation to participation model. Primary (and other) preventive action is stimulated, also financially, at several levels. 5
6 E-health module embedded in Collaborative Occupational healthcare (ECO) David Rebergen, Moniek Vlasveld, Christina van der Feltz
7 Physical > mental condition 10-18% workers Western societies mental problems Netherlands: 30% work incapacity due to mental health problems, 11% depressive disorder Societal costs 7,5 miljard Euro, presenteism not included!
8 Background Major depressive disorder (MDD) is associated with presenteeism and absenteeism Evidence-based treatments for MDD are available but many obstacles in real life AND there is a lack of focus on work The collaborative care model, focused on work, as an answer to this problem
9 Background Collaborative care = Organisational intervention Care manager Collaboration between health care professionals Monitoring of progress of the individual patient
10 Background Dutch social legislation Two years of wage compensation by employer Employers are obliged to hire occupational physician Employer and employee both responsible After two years of sick leave: medical examination No cause based system Trimbos-instituut
11 Background Depression Initiative Dutch initiative on improving treatment for depression Trials on the (cost)effectiveness of collaborative care in: primary care setting (also on anxiety disorders) general hospital setting occupational health setting (CC:DOC) June 2006 June 2010 Trimbos-instituut
12 Design current RCT CC:DOC Randomized Controlled Trial Aim Evaluation of the effectiveness of collaborative care in the occupational health setting versus care as usual in terms of: 1) severity of depressive symptoms / Quality of Life 2) return to work/presenteeism (Tic-P) 3) cost-effectiveness from a societal perspective Intervention: a collaborative care treatment with elements focused on individual, workplace and the health care system. Provided by occupational physician. Trimbos-instituut
13 Intervention CC:DOC Content of collaborative care intervention in this study: Problem Solving Treatment (PST) Workplace intervention Optional: antidepressant medication according to a treatment algorithm Manual guided self-help Monitoring of the progress of treatment with the PHQ9 every 2 weeks When needed according to this monitoring: intensifying treatment Web-based tracking system Treatment team: Occupational physician (care manager) (Consultant) psychiatrist Trimbos-instituut
14 Treatment algorithm Treatment plan depending on risk profile (e.g. history of depression?) and preference patient: antidepressant medication or not Monitoring of symptoms with PHQ9 every 2 weeks Every 6 weeks: need for intensifying treatment? Pre-defined criteria Antidepressant medication algorithm If necessary: consultation of psychiatrist Maximum 18 weeks Remission? (0-4) Relapse prevention and monthly phone calls No remission? (>4) Referral secondary care Trimbos-instituut
15 Tracking system Secured, online system Supports the care manager in adhering to the treatment algorithm Communication between care manager, GP and consultant psychiatrist Future: also log-in by patient In the trials: a check for the researchers/psychiatrist whether algorithm is followed Trimbos-instituut
16 Opening screen and to do list Trimbos-instituut
17 Your list of patients as a care manager Trimbos-instituut
18 Adding new patients Trimbos-instituut
19 Time to start the algorithm! Session 1 Trimbos-instituut
20 Fill in the PHQ9 Trimbos-instituut
21 Fill in the treatment plan Trimbos-instituut
22 High risk for suicide in the PHQ9 Trimbos-instituut
23 Consulting the psychiatrist Trimbos-instituut
24 Signal that treatment needs to be intensified (less than 5 points approvement)
25 Remission accomplished: treatment can be finished
26 Experiences tracking system Care managers need to be stimulated to use the system When using, they consider it a helpful tool They need practice
27 Current situation Recruitment Workers on sick leave between 4 and 12 weeks were recruited by screener: depression subscale PHQ9 (>10) Inclusion of workers by structured telephone interview (MINI) according to DSM-IV criteria 125 workers included between , just finished Successful randomization on patient level First results expected in 2010 New grant (E ,-) Cluster RCT ECO with improved tracking system including patient involvement and e-mental health ECO just started October 2010
28 Projects Trimbos Dashboard Stressprevention (Developed algorithm): Digital Screening multimorbid mental health and indicated care Mental fitness: positive psychology (Linda Bolier) Preventive internet course stress: Sterk op je werk (Martijn Bool) Collaborative care for depressed workers RCT Moniek Vlasveld: inclusion finished, results expected 2010 ECO-trial: start October 2009, first results expected 2012 Mentalhealth&Work ( (interactive) platform, in collaboration with Coronel-institute Work & Health
29 Mentalhealth&Work
30 Thank you for your attention and inspiration! Contact David Rebergen Trimbos-instituut
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