Psychotherapy and change in mental health-related work disability: a prospective Finnish population-level register-based study with a quasi-experimental design
Open Access
- 16 September 2022
- journal article
- research article
- Published by BMJ in Journal of Epidemiology and Community Health
- Vol. 76 (11), 925-930
- https://doi.org/10.1136/jech-2022-218941
Abstract
Background Mental disorders are a major cause of work disability among the working-age population. Psychotherapy has shown to be an effective treatment for mental disorders, but the evidence is mainly based on small-scale randomised trials with relatively short follow-ups. We used population-based register data to examine the association between statutory rehabilitative psychotherapy and change in depression or anxiety-related work disability. Methods We drew a nationally representative sample of the working-age population (aged 18–55 in 2010). The study group comprised all those who started rehabilitative psychotherapy in 2011–2014. A total of 10 436 participants who were followed from 3 years prior to 4 years after the onset of rehabilitative psychotherapy. This resulted in 83 488 observations. The annual total number of mental health-related work disability months (0 to 12) was calculated from the total number of annual compensated sickness absence and disability pension days. A quasi-experimental interrupted time series analysis was applied. Results The onset of rehabilitative psychotherapy marked a decline in work disability in comparison to the counterfactual trend. Specifically, a 20% decrease in the level (incidence rate ratio, IRR 0.80; 95% CI 0.76 to 0.85) and a 48% decrease in the slope (IRR 0.52; 95% CI 0.50 to 0.54) of work disability were detected in comparison to the counterfactual scenario. No significant gender differences were observed. The decline in work disability was the steepest in the oldest age group. Conclusions This study suggests that statutory psychotherapy may decrease work disability at the population level. However, further evidence of causal inference and the potential heterogeneity of the association is required.Keywords
Funding Information
- Social Insurance Institution of Finland (18/26/2020)
This publication has 26 references indexed in Scilit:
- Interrupted time series regression for the evaluation of public health interventions: a tutorialInternational Journal of Epidemiology, 2016
- Educational differences in disability retirement among young employees in Helsinki, FinlandEuropean Journal of Public Health, 2015
- The efficacy of short-term psychodynamic psychotherapy for depression: A meta-analysis updateClinical Psychology Review, 2015
- Is there an excess of significant findings in published studies of psychotherapy for depression?Psychological Medicine, 2014
- Reporting of harms in randomized controlled trials of psychological interventions for mental and behavioral disorders: A review of current practiceContemporary Clinical Trials, 2014
- Use of Interrupted Time Series Analysis in Evaluating Health Care Quality ImprovementsAcademic Pediatrics, 2013
- Prediction of the outcome of short- and long-term psychotherapy based on socio-demographic factorsJournal of Affective Disorders, 2012
- Negative effects from psychological treatments: A perspective.American Psychologist, 2010
- The Elephant on the Couch: Side-Effects of PsychotherapyAustralian & New Zealand Journal of Psychiatry, 2009
- Functional disability of mental disorders and comparison with physical disorders: a study among the general population of six European countriesActa Psychiatrica Scandinavica, 2005