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PRO*ACTIVE project combines psychotherapy with work: MHH team investigates effects of early reintegration
Mental illnesses, especially depression, are the second most common cause of sick leave (AU). Uncertain initial diagnoses and long waiting times for psychotherapy delay treatment and worsen the prognosis. Returning to work becomes a distant prospect. However, long periods of incapacity for work are not only a burden on the social security system, they often also have a negative impact on the recovery of those affected. With the PRO*ACTIVE project, the Department of Psychiatry, Social Psychiatry and Psychotherapy at Hannover Medical School (MHH) is taking a new approach: the programme aims to proactively promote the rapid reintegration of patients with depression into the work process. The project will start this autumn and is being funded by the Innovation Fund of the Federal Joint Committee (G-BA) with around 4.2 million euros. The project partners are the AOK Lower Saxony, the MHH Institute of Biometry and the MHH Institute of Epidemiology, Social Medicine and Health Systems Research.
Long periods of incapacity for work partly unnecessary
Days of sick leave due to mental illness have increased continuously in recent years. For the first half of 2024, the DAK Health Report recorded around 182 days of absence per 100 insured persons. In 2023, there were 159 days of absence in the same period, which corresponds to an increase of 14.3 per cent. Does a long absence from work help depressed people heal? ‘No, for the vast majority of patients with depression, long periods of incapacity to work have a negative effect,’ says Professor Dr Kai Kahl from the Department of Psychiatry, Social Psychiatry and Psychotherapy. For a long time, the view prevailed that patients had to be fully recovered through psychotherapy before they could return to work.
But that's not true. ‘Keeping those affected away from work makes no sense at all. It is much better to adapt the therapy to the workplace from the outset and organise the working conditions in such a way that they support the recovery process.’ Work regularly provides structure, social contact and appreciation. These are all things that are good for depressed people.
Rapid outpatient care
This is exactly what the PRO*ACTIVE project, which Professor Kahl is launching together with his colleague Dr Ivo Heitland, is all about. The project involves four steps. Firstly, the cooperation partner AOK identifies insured persons with a diagnosis of depression and the risk of long-term incapacity to work. They are then proactively contacted by case managers from the health insurance company and referred to the project. The third step involves a screening at the MHH. ‘We check the diagnosis of depression in the second opinion procedure and ensure that the patients receive outpatient psychotherapeutic treatment promptly,’ explains Dr Heitland. Step four is the actual therapy. This takes place close to home in specially certified psychotherapeutic co-operation practices.
Comparison with standard therapy
A total of 250 patients are taking part in PRO*ACTIVE. Half of them receive standard psychotherapy, while the other half receive psychotherapy in which their reintegration into work is actively supported by psychotherapy. Both treatments are cognitive behavioural therapies with 25 sessions. ‘In the workplace-oriented therapy, the therapists also support the study participants in preparing for their return to work and, where possible, help them to do so,’ says Dr Heitland. The patients themselves make contact with the employer, with whom they discuss the specific conditions for returning to work. At the end of the therapy, a second appointment is scheduled at the MHH. Professor Kahl, Dr Heitland and their team then use diagnostic tests to check the individual success of the therapy and compare the results with those of the control group. The MHH Institute of Biometry analyses the project data scientifically.
Lower costs for the social security system
‘Our experience so far shows that mild to moderately depressed patients in particular benefit when the workplace is taken into account from the start of treatment,’ says Dr Heitland. ‘They recover more quickly and don't become increasingly distant from their work due to long periods of sick leave.’ Therefore, everything speaks in favour of workplace-related therapy for depression. ‘What's more, this type of therapy also has a positive impact on health economics,’ emphasises Professor Kahl. ‘Shorter periods of sick leave reduce costs for health insurance companies and protect the social security system. ’Professor Kahl and Dr Heitland hope that the PRO*ACTIVE project will take a further step towards ensuring that work-related psychotherapy can be incorporated into standard care.
For further information, please contact Dr Ivo Heitland,heitland.ivo-aleksander@mh-hannover.de and Professor Dr Kai Kahl, kahl.kai@mh-hannover.de.
Which therapy is best for people with depression? Dr Ivo Heitland (left) and Professor Dr Kai Kahl a ...
Copyright: Karin Kaiser/MHH
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