Improving Access to Mental Health Care by Delivering Psychotherapeutic Care in the Workplace: A Cross-Sectional Exploratory Trial

PLoS One. 2017 Jan 5;12(1):e0169559. doi: 10.1371/journal.pone.0169559. eCollection 2017.

Abstract

Objective: Common mental disorders like mood and anxiety disorders and somatoform disorders have high costs, yet under-treatment is still frequent. Many people with common mental disorders are employed, so the workplace is potentially a suitable context in which to provide early treatment. Our study investigates whether a change of setting (workplace versus standard care) improves access to treatment for common mental disorders.

Methods: Conditional latent profile analysis was applied to identify user profiles for work ability (WAI), clinical symptoms like depression (patient health questionnaire depression, PHQ-9), health-related quality of life (QoL, SF-12), and work-related stress (Maslach Burnout Inventory, irritation scale). Patients were recruited consecutively, via psychotherapeutic consultation in the workplace (n = 174) or psychotherapeutic consultation in outpatient care (n = 193).

Results: We identified four user profiles in our model: 'severe' (n = 99), 'moderate I-low QoL' (n = 88), 'moderate II-low work ability' (n = 83), and 'at risk' (n = 97). The 'at risk' profile encompassed individuals with reduced work ability (36.0, 34.73 to 37.37), only mild clinical symptoms (PHQ-9 5.7, 4.92 to 6.53), no signs of work-related stress and good quality of life. A higher proportion of the 'at risk' group than of the 'severe' group sought help via the psychotherapeutic consultation in the workplace (OR 0.287, P < 0.01); this effect remained after controlling for gender.

Conclusions: Offering secondary mental health care in the workplace is feasible and accepted by users. Offering treatment in the workplace as an alternative to standard outpatient settings is a viable strategy for improving access to treatment for common mental disorders.

MeSH terms

  • Adult
  • Ambulatory Care
  • Anxiety Disorders / therapy
  • Cross-Sectional Studies
  • Depression / therapy
  • Female
  • Humans
  • Logistic Models
  • Male
  • Mental Health*
  • Middle Aged
  • Quality of Life
  • Referral and Consultation
  • Somatoform Disorders / therapy
  • Workplace

Grants and funding

This study was funded by the young scientists program of the German network "Health Services Research Baden-Wuerttemberg" of the Ministry for Science, Research and Arts in collaboration with the Ministry for Work and Social Affairs, Family, Women, and Senior Citizens, Baden-Wuerttemberg. The company CASSIDIAN (now Airbus) provided material support for the evaluation of the psychosomatic consultation in the context of company health management. The work of the Institute of Occupational and Social Medicine and Health Services Research Tuebingen is supported by an unrestricted grant of the employers' association of the metal and electric industry Baden-Wuerttemberg (Suedwestmetall). Suedwestmetall provided support in the form of partial salary for MAR, and Daimler AG provided support in the form of salary for DM. The specific roles of these authors are articulated in the 'author contributions' section. Suedwestmetall, Daimler AG and CASSIDIAN (now Airbus) did not have any role in patient recruitment, analysis, decision to publish, or preparation of the manuscript.