Return to work in adults with adjustment disorders, PST

Jorma Komulainen

Level of evidence: C

In patients with adjustment disorders, problem solving therapy (PST) may enhance partial return to work but not full return to work at one-year follow-up.

The objective of this systematic review «Arends I, Bruinvels DJ, Rebergen DS ym. Interventi...»1 was to assess the effects of interventions facilitating RTW for workers with acute or chronic adjustment disorders.

Randomised controlled trials (RCTs) evaluating the effectiveness of interventions to facilitate RTW of workers with adjustment disorders compared to no or other treatment were selected. Eligible interventions were pharmacological interventions, psychological interventions (such as cognitive behavioural therapy (CBT) and problem solving therapy), relaxation techniques, exercise programmes, employee assistance programmes or combinations of these interventions. The primary outcomes were time to partial and time to full RTW, and secondary outcomes were severity of symptoms of adjustment disorder, work functioning, generic functional status (i.e. the overall functional capabilities of an individual, such as physical functioning, social function, general mental health) and quality of life.

Nine studies reporting on 10 psychological interventions and one combined intervention were included. The studies included 1546 participants. No RCTs were found of pharmacological interventions, exercise programmes or employee assistance programmes. Seven studies were assessed as having low risk of bias and the studies that were pooled together were comparable. For those who received no treatment, compared with CBT, the assumed time to partial and full RTW was 88 and 252 days respectively. Based on two studies with a total of 159 participants, moderate-quality evidence showed that CBT had similar results for time (measured in days) until partial RTW compared to no treatment at one-year follow-up (mean difference (MD) -8.78, 95 % confidence interval (CI) -23.26 to 5.71). There was low-quality evidence of similar results for CBT and no treatment on the reduction of days until full RTW at one-year follow-up (MD -35.73, 95 % CI -113.15 to 41.69) (one study with 105 participants included in the analysis). Based on moderate-quality evidence, problem solving therapy (PST) significantly reduced time until partial RTW at one-year follow-up compared to non-guideline based care (MD -17.00, 95 % CI -26.48 to -7.52) (one study with 192 participants clustered among 33 treatment providers included in the analysis), but there was moderate-quality evidence of no significant effect on reducing days until full RTW at one-year follow-up (MD -17.73, 95 % CI -37.35 to 1.90) (two studies with 342 participants included in the analysis).


  1. Arends I, Bruinvels DJ, Rebergen DS ym. Interventions to facilitate return to work in adults with adjustment disorders. Cochrane Database Syst Rev 2012;(12):CD006389 «PMID: 23235630»PubMed