Web-Enhanced Return-to-Work Coordination for employees with common mental disorders: Reduction of sick leave duration and relapse

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This study aims to assess the effectiveness of PRATICA dr , a web application facilitated by a Return-to-Work Coordinator (RTW-C), with a focus on reducing sick leave duration and preventing relapse in individuals with CMDs. Methods PRATICA dr , designed to enhance collaboration among Return-to-Work (RTW) stakeholders and provide systematic support throughout the RTW process, was evaluated in a quasi-experimental study. Survival analyses were used to compare sick leave durations and relapses between the experimental group (PRATICA dr with RTW-C), and control groups (RTW-C only). Both conditions had equal distribution of 50% from a large public health organization (n = 35) and 50% from a large private financial organization (n = 35). Mixed linear models were used to observe changes in clinical symptoms over time, especially for the experimental group. Results The experimental group demonstrated significantly shorter sick leave durations and fewer relapses compared to the control group. Notably, the average absence duration was close to 3 months shorter in the experimental group. This difference was found when the RTW-C intervention (rehabilitation care) began 2 months after the onset of sick leave. Relapses occurred only in the control group (13.2%). The absence of relapses in the experimental group is noteworthy, along with the significant decrease in depressive and anxious symptoms over time. Conclusions The findings suggest that incorporating PRATICA dr into RTW-C intervention can lead to substantial cost savings by facilitating coordination among stakeholders and guiding the RTW process with validated tools. Initiation of RTW-C intervention alongside PRATICA dr within the first month of absence is recommended for optimal health and work outcomes. web application stakeholder return-to-work coordinator clinical symptoms cost-savings Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Common mental disorders (CMDs) are highly prevalent in workplace settings, and have become a significant public health challenge [ 1 , 2 ]. CMDs, including depressive and anxiety disorders, along with adjustment disorders, account for 30–50% of reasons for workplace absenteeism [ 3 – 5 ]. Recurrence rates among returning employees range from 20–30% [ 6 ], regardless of the specific CMD and time evaluation, with projected costs reaching $ 3–6 trillion by 2030 [ 7 , 8 ]. In Canada, CMDs incur an estimated $ 51 billion in costs, including medical expenses, and productivity loss [ 9 ]. In the province of Québec, the average cost is $ 125,000 for employee relapse compared to $ 69 000 for those with CMDs without relapse [ 10 ]. Absences due to CMDs impact individual’s professional identity, skills confidence, and exacerbate symptoms, affecting work environments [ 11 ]. Stakeholders including employers, HR professionals, managers, and health professionals across diverse sectors must collaborate to develop strategies to reduce sick leave duration and prevent relapses upon return to work [ 12 ]. Grounded in the literature and tailored for large Canadian organisations, both public and private, the Return to Work (RTW) process is structured into three phases with 10 milestones [ 13 ]. Phase 1 involves initiating sickness absence management, Phase 2 focuses on treatment rehabilitation and RTW preparation, and Phase 3 encompasses gradual RTW and follow-up. The RTW process entails a series of interactions and interventions conducted by various stakeholders within diverse environments and systems, such as work (e.g., employer, manager, unions), health (e.g., family physician, rehabilitation professionals), and insurance (e.g., insurer) [ 14 , 15 ]. Improving communication and collaboration among these stakeholders is crucial for reducing sick leave duration and preventing relapses [ 16 ]. As the responsibility for the RTW process is distributed among multiple stakeholders, there is a risk of responsibility fragmentation and gaps in orchestrating actions, leading to efficiency and quality issues [ 17 ]. A meta-synthesis of qualitative research on mental health and work issues highlights a lack of coordination among stakeholders from the three systems mentioned above [ 18 ]. Efforts towards building more integrated healthcare systems internationally aim to address these challenges [ 19 ]. Many Scandinavian countries, particularly Finland, Norway, Sweden, and Denmark have implemented RTW Coordinators (RTW-C) to enhance communication and collaboration among stakeholders involved in the RTW process [ 20 , 21 ]. Timely RTW is crucial to prevent permanent work disability, and RTW-C provision aims to improve program timing and planning [ 22 ]. Despite several literature reviews and meta-analyses of randomised controlled trials, there is ongoing debate about the impact of the RTW-C [ 22 , 23 ]. Some studies suggest that the RTW-C model, or certain components of the model, may reduce the duration of work disability, while others argue that offering RTW coordination has no discernible benefits compared to usual practice [ 21 , 22 , 24 ]. Based on the Cochrane review by Vogel et al. [ 23 ], the uncertainty in evidence regarding the benefits of RTW coordination programs may be attributed to the low quality of research and variations in the organization and implementation of these programs. Among the studies included in Vogel et al. [ 23 ], only two focused exclusively on CMDs, and there is no uniform definition of RTW coordination programs across studies. It might be possible that the coordination model, where the RTW-C is placed in specialist healthcare services without real possibilities to coordinate and accommodate at the workplace, does not facilitate RTW [ 20 ]. In the literature, coordination among RTW stakeholders is described as vertical, spanning different levels and institutions, and horizontal, occurring within one level or service [ 19 ]. Dialogue mechanisms between employees and managers [ 25 ] or occupational physicians [ 26 ] in Europe positively impact RTW. Despite numerous stakeholders playing crucial roles throughout the RTW process, coordination often involves exclusive dyadic relationships [ 13 , 14 ]. Timing of intervention and systematic, centralized information are also critical. Online mental health technologies offer a solution to access issues in mental health services and can enhance coordination among stakeholders [ 27 ]. Transforming effective RTW interventions into digital solutions can increase accessibility regardless of location and time [ 28 ]. Furthermore, a recent meta-analysis has been conducted on online interventions in the field of mental health and work [ 29 ], along with a meta-review of mobile applications deployed in mental health [ 30 ] indicating no application or web platform facilitating RTW for CMDs. Together, the applications identified in these meta-analyses, meta-review, and more recent studies do not address the issue of coordinating actions among multiple RTW stakeholders. They generally focus on a single user or a dyad (e.g., the occupational physician and the employee on sick leave). To fill the existing gap in evidence-based digital support for sustainable RTW for individuals with CMDs and RTW stakeholders, this study aimed to implement a web application tailored for this purpose. The web application, named PRATICA dr , is specifically designed for employees with CMD and RTW stakeholders, including RTW-C, General Practitioners (GPs), Managers, and Occupational and Health Professionals. Following Vogel et al.’s [ 23 ] recommendation, we not only track RTW occurrences but also monitor relapses into sick leave, providing a detailed intervention description. In our quasi-experimental study, we evaluated the effectiveness RTW-C assisted by PRATICA dr , compared to a usual (control) group receiving standard RTW-C support without PRATICA dr . Our hypotheses were as follows: Intergroup Comparisons (experimental vs control group): Hyp1: PRATICA dr + RTW-C participants will have shorter sick leave duration compared to the usual intervention (only RTW-C). Hyp2: PRATICA dr + RTW-C participants will have fewer relapses during follow-up than those in the usual intervention group. Intragroup Analysis (experimental group only): Hyp3: Participants in the PRATICA dr group will observe a reduction in depressive and anxious symptoms over time. Methods Study Design and Participant Recruitment For this quasi-experimental preliminary study, participants were recruited into the experimental condition, or to the control condition. Inclusion criteria for both groups were: 1) a documented sick-leave prescription with a diagnosis of a CMD (depression, anxiety and adjustment disorders), 2) the ability to communicate in French, and 3) receiving services from a RTW-C in a participating clinic (from the private or public sector). For the control condition, the criteria were the same, but with added matching on key variables (see below). We recruited 40 participants for the experimental group by inviting them to take part in the PRATICA dr group; three were excluded at baseline if they no longer fit inclusion criteria (i.e. not currently returning to work due to physical ailment). To match, we recruited 37 participants to take part in the control condition. Additionally, three from the control group were later excluded for reasons similar to those in the experimental group such as undergoing surgery or pregnancy. Both conditions had equal distribution of 50% from a large public health organization (n = 35) and 50% from a large private financial organization (n = 35). Matching criteria included demographic and clinical characteristics, employment-related factors (Table 1 ). Given that all participants in the experimental condition had recently returned to work after a sick leave due to common mental illness, this was also a matching criterion. Fisher exact tests showed no significant differences between groups (Table 1 ). Duration of sick leave and relapses were assessed three months after RTW for both groups. Relapse is defined as being for a minimum of 5 working days due to reasons associated with a CMD. Following the three phases of the RTW process and applicable only to the experimental group, clinical measures (depressive and anxious symptoms) were administered at baseline (pre-intervention, phase 1), intervention (phase 2), during therapeutic RTW (phase 3), as well as 1-month follow-up (post-therapeutic RTW) and 3-month follow-up (post-therapeutic RTW). Sustainable RTW is defined as 30 days of work following the sickness benefit period [ 31 ]. Table 1 Sociodemographic information for experimental and group controls according to the sector of activity Public sector Private sector Variables Experimental (n = 18) Control (n = 17) Experimental (n = 19) Control (n = 16) P value Female 17 16 18 15 Age < 45 years 9 7 10 8 0.91 ≥ 45 years 9 10 9 8 Diagnosis Adjustment disorder 15 11 11 10 0.50 1 Depression 1 5 6 4 Anxiety 2 1 2 2 Type of employment Nurse Social worker Beneficiary caregiver Support staff Administrative officer Counsellor Director Analyst Customer service Technical support 9 4 3 1 1 - - - - - 6 3 2 4 3 - - - - - - - - - - 10 5 2 1 1 - - - - - 4 5 3 4 3 0.47 1 0.27 1 Intervention and procedures Participants in the experimental group were provided access to the PRATICA dr application, facilitated by the research team. PRATICA dr is a technology-driven solution developed from evidence-based interventions with the aim of enhancing collaboration between RTW stakeholders and providing systematic support throughout the RTW process. Key features of PRATICA dr include: 1) Facilitation of collaboration among multiple RTW stakeholders across healthcare, enterprise, and insurance sectors, with a focus on the RTW-C, 2) User-friendly interface tailored for employees on sick leave and RTW stakeholders, 3) Integration of each stakeholder’s action into the sick leave employee’s RTW process, 4) Sequential process aligned with the three phases of the RTW, 5) Integration of organizational-specific best practice guides for RTW stakeholders, 6) Inclusion of validated tools covering various topics such as RTW barriers, self-efficacy, workplace accommodations, and clinical symptoms, 7) Centralization of information through data collection, 8) Capacity to handle large volumes of cloud-based data, ensuring accessibility and adaptability for tracking employee progress, 9) Assurance of confidentiality through encrypted personal data storage. Before the intervention, the research coordinator thoroughly explained the research protocol and the sequential phases of the RTW program integrated into the application to each participant and RTW-C. Each participant was assigned a dedicated set of stakeholders involved in their RTW process, including a RTW-C, healthcare provider (e.g., family physician or nurse practitioner), rehabilitation professional (e.g., occupational therapist or physiotherapist), manager, and insurer. Upon obtaining informed consent from the participant, the RTW-C initiated contact with these stakeholders, granting them access to the application via email communication. The roles and responsibilities of each stakeholder were clearly communicated, with a focus on the availability of best practice guides embedded within the application. Practical guides within the application detailed the expected roles and actions of all stakeholders as recommended in the literature [ 14 ]. Upon initial login to the application, participants were prompted to provide electronic consent, signifying the start of the PRATICA dr intervention. The application followed a predetermined workflow that incorporated evidence-based best practices [ 14 ] and the RTW program developed by the research team [ 13 ]. This structured approach ensured uniformity and adherence to established guidelines throughout the intervention. Ethical approval for this study was obtained from the research ethics board of the CIUSSS de l'Est-de-l'Île-de-Montréal (#MP-12-2018-1155 and #2018 − 1052). Depressive and anxiety symptoms To assess CMD symptoms for the participants in the experimental group, we utilized the Patient Health Questionnaire (PHQ-9) [ 32 ] and the Generalized Anxiety Disorder Scale (GAD-7) [ 33 ]. The PHQ-9 includes 9 items evaluating depressive symptoms, while the GAD-7 consists of seven items assessing anxiety symptoms. Both scales employ a 4-level Likert scale (0 = never, 1 = several days, 2 = more than half the time, 3 = almost every day) for participant responses. Total scores are calculated by summing the responses, with specific scores ranges indicating varying levels of depression or anxiety severity. For the PHQ-9, reliability is excellent (α = 0.89) and test-retest reliability over a 7-day period is also high (ICC = 0.92) [ 34 ]. Similarly, the GAD-7 demonstrates excellent reliability (α = 0.92) and good test-retest reliability within a week (ICC = 0.83) [ 33 ]. A score of ≥ 10 on both scales, typically indicates moderate intensity of depression or generalized anxiety symptoms. These measures were administered at each assessment time point including baseline or pre-intervention, post intervention, therapeutic RTW, 1-month and 3-month follow-ups. Comparisons between the experimental groups (private and public organisations) at the baseline revealed no significant differences in depressive and anxious symptoms (p-values of 0,58 and 0,88, respectively), enabling subsequent analyses combining both groups. Interestingly, as Nieuwenhuijsen et al. [ 35 ] demonstrated, the distinction between depressive and other disorders such as anxiety disorders becomes less relevant as new insights are emerging based on transdiagnostic psychopathology (see HiTop- [ 36 ]). This approach involves investigating the importance and connections of individual symptoms rather than disorders. Analyses Statistical analyses were performed using R [ 37 ] and the survival package [ 38 ]. Survival analyses were employed for H1 and H2. Cox regression analysis [ 39 ] was used to estimate the time until event occurrence, and the results were presented in terms of hazard ratios (HRs). As previously mentioned, all participants, both in experimental and control groups, returned to work. In the model, the survival time variable was “the duration of sick leave” measured in days. A Kaplan–Meier survival curve was utilized to estimate cumulative survival probabilities and assess RTW patterns over time. Additional analyses were conducted to assess the effect of the onset of the rehabilitation care on sick leave duration in both experimental and control groups. The median duration of the onset of the rehabilitation care (i.e. duration until the RTW-C assumes the responsibility after the onset of sick leave) was approximately 2 months (60 days), used as a threshold for analyses (< 60 days vs. ≥60 days). H2 was tested using a Fischer exact test due to the small sample size, determining differences between the experimental and control groups. To test hypothesis H3, regarding mean differences over time, mixed linear models were estimated. The models were adjusted using the following formula: \({y}_{it}={\beta }_{0i}+ {\beta }_{1t}+ {ϵ}_{it}\) \({\beta }_{0i}={\beta }_{0}+ {\xi }_{i}\) Where \({y}_{it}\) represents the dependent variable of subject i at time t . \({\beta }_{0i}\) represents a random coefficient comprising a fixed part \({\beta }_{0}\) and a random effect \({\xi }_{i}\) . \({\beta }_{1t}\) represents the time adjustment (2, …, 5) relative to time 1 ( \({\beta }_{11}=0\) ). Finally, \({ϵ}_{it}\) is a residual term for which we assume that the variance is a function of time ( \({ϵ}_{it}\sim \text{N}\left(0,{\sigma }_{t}^{2}\right)\) – variance heteroskedastic). This model was constructed using the nlme package. Results Figure 1 presents a graphical depiction of the Kaplan–Meier results for sick leave duration in both experimental and control groups. The survival curve indicates that 50% of employees in the experimental group returned to work within 215 (sd = 84) days, while it took 300 (sd = 139) days for the control group. The median sick leave duration was 7.2 months for the experimental group and 10 months for the control group, showing a nearly 3 months (or 85 days) difference in favor of the experimental group (HR = 2.5; p < .001). Figures 2 and 3 depict Kaplan–Meier estimates for sick leave duration in both groups, categorized by duration of the rehabilitation care following the onset of sick leave (< 60 days vs. ≥60 days). Figure 2 shows similar median sick leave durations (5.3 months) when the period of time between the start of sick leave and the start of the rehabilitation care was less than 2 months after the sick leave (HR = 0,87, p = 0,80). In Fig. 3 , the experimental group had a median sick leave duration of 7.7 months (231 days; sd = 62) compared to 10,4 months (312 days; sd = 130) for the control group (HR = 3,44, p < 0,001) when the period of time between the start of the rehabilitation care exceeded 2 months. Overall, the use of PRATICA dr by the RTW-C significantly reduced sick leave duration, particularly when rehabilitation care duration exceeded 2 months. Regarding relapses, a significant difference in relapse rates was found between the experimental and control groups (p = 0.045) based on a Fisher exact test. In the control group, 4 individuals (13,2%) experienced relapses within 3 months after RTW, while no relapses were observed in the experimental group. In terms of clinical symptoms within the experimental group (private and public), significant mean differences over time were observed, particularly for depressive symptoms between T0 and T1 (p = 0,012) and between T2 and T3 (p = 0,038) (Fig. 4 ). Similarly, for anxiety symptoms (Fig. 4 ), significant differences were noted between T0 and T1 (p = 0,045) and between T2 and T3 (p = 0,002). Individuals exhibited clinically anxious and depressive scores at T0 (close to 10), whereas during therapeutic RTW (T3), scores dropped below 5, indicating minimal or no clinical symptoms upon reintegrating into their work environment (Fig. 4 ). Discussion Mobile applications and web platforms are increasingly being used for self-management of CMDs; however, there is a dearth of available eHealth applications providing evidence-based digital support for individuals with CMDs upon their RTW. Furthermore, other RTW stakeholders, such as managers and health professionals, are inconsistently integrated, sometimes only with dyad stakeholders [ 25 , 26 ]. The RTW-C has emerged as a key player, tasked with orchestrating all actions involving RTW stakeholders stemming from various systems. Research should not only focus on people returning to work (RTW) but also on sustainable RTW, examining how well individuals can remain at work post-sick leave. This is vital due to the challenges many workers encounter in maintaining work following RTW. This quasi-experimental study compared the use of the PRATICA dr web platform by a RTW-C to the usual intervention of a RTW-C, on work outcomes such as duration of absence and relapses after 3 months following the RTW. Clinical variables were systematically evaluated for the experimental group only, to document their evolution over time, from the beginning of the intervention up to 3 months after the RTW. Results revealed significantly shorter sick leave duration and fewer relapses in the experimental group compared to the control group. Specifically, the average absence duration was 85 days shorter in the experimental group. This difference was found when the RTW-C intervention (rehabilitation care) began 2 months after the onset of sick leave. Relapses, occurring only in the control group (13.2%), were evenly distributed before and after the two-month of the RTW-C intervention without the use of PRATICA dr . In their systematic review and meta-analysis of randomized controlled trials (RCTs) investigating interventions for CMDs and RTW, Nigatu et al. [ 4 ] reported an average sick-leave duration until RTW ranging from 151 to 165 days for intervention and control groups, respectively. The mean difference was approximately 13 days in favor of the experimental group, indicating a low effect size. Our study aligns with these findings, particularly when the RTW-C starts rehabilitation care within two months of absence. Specifically, both experimental and control groups in our study had an average absence duration of 159–160 days. Our study provides nuanced insights, demonstrating that when RTW-C intervention begins two months or more after the first day of absence, sick-leave duration is longer: 231 days for the experimental group and 312 days for the control group, with an 81-day advantage favoring the experimental group. Nigatu et al. [ 4 ] suggested that even a 13-day difference in sick leave duration could have significant economic implications, leading to substantial savings in healthcare and employment costs at the population level. Tikka et al. [ 16 ] supported this idea, highlighting that a mere 5-day reduction in cumulative sick leave with RTW coordination could save €790 per person in Finland compared to usual care. In Finland and other Scandinavian countries, RTW-C is a governmental measure, with results indicating the benefit of short sick leave durations and recommending the use of RTW-C. Our study, incorporating RTW-C in both experimental and control groups, suggests that the addition of PRATICA dr , a web platform guiding RTW with validated tools and systematic coordination with stakeholders, could result in significant cost savings. Relapse rates in CMDs post-RTW have been highlighted as significant as RTW itself in the literature. Nielsen et al. [ 6 ] reported recurrence rates among returning employees ranging from 20–30%, irrespective of the specific CMD or evaluation timing. Consistent with these findings, our study found a 13.2% relapse rate (n = 4) within three months post-RTW, with no relapses observed in the experimental group. Economically, a CMD relapse after RTW incurs significant costs, with a total of 340,000 euros for four employees experiencing relapses, equivalent to $ 125,000 each in Quebec (or 85,000 euros). The use of PRATICA dr appears to mitigate relapse risks, reinforcing sustainable RTW and cost-savings efforts. Relapses were observed not only in employees receiving intervention after 2 months of sick leave, but also in those with more prompt RTW-C intervention (< 2 months). This suggests that PRATICA dr may effectively prevent relapses at any point in the RTW-C intervention. Additionally, the absence of relapses in the experimental group is noteworthy, along with the significant decrease in depressive and anxious symptoms over time. Despite initial moderate to severe symptoms, employees gradually RTW exhibited minimal or very mild symptoms, with stabilization observed during the 3-month follow-up. This stabilization may help mitigate the risk of relapses. Clinical implications The findings suggest that a web platform coupled with a RTW-C intervention decreases the duration of absence in employees with CMDs. Employing a low-intensity RTW intervention using PRATICA dr , before two months of absence appears a suitable strategy. However, relapses could occur two months prior to the utilization of PRATICA dr . Therefore, initiating RTW-C intervention + PRATICA dr from the first month of absence might be even better. Participants who had recovered no longer felt the need to engage with an application such as PRATICA dr and incomplete questionnaires [ 12 , 40 ]. For such cases, a short period after the onset of sick leave might suffice for spontaneous remission. One month or 30 days is suggested as an acceptable timeframe for the initial intervention, aligning with existing research [ 41 ]. This study also emphasizes the presence of a well-equipped RTW-C, especially for absences exceeding two months. PRATICA dr has the advantage of incorporating the necessary guidelines for the RTW process, along with tools to guide RTW-C intervention, including symptom assessment, workplace accommodations, and perceived obstacles to returning to work. Additionally, PRATICA dr outlines the roles and actions that each stakeholder should adopt in the form of practical guides. These tools and guidelines facilitate better support for employees by the RTW-C in the context of work rehabilitation. Furthermore, other stakeholders accessing PRATICA dr can real-time access relevant information due to centralized data, with medical information available exclusively to healthcare professionals. Training on these elements becomes crucial for effective RTW-C support. Dol et al. [ 42 ], in their systematic review, conducted evidence synthesis (moderate to strong) regarding the best intervention components when there is an RTW-C, such as training RTWCs, developing an RTW plan, ergonomic worksite evaluation, communication between different stakeholders, and identifying barriers and facilitators to RTW. Dol et al. [ 42 ] also discussed the stressfulness of interactions with the RTW-C as a major contributing factor to positive RTW outcomes in their review. As for individuals with severe mental disorders, the working alliance inventory could be an interesting asset for sustainable RTW for people with CMDs followed by a RTW-C, assessing the dyadic interaction between the RTW-C and the employee, their mutual agreement on recovery goals, and sustainable RTW, along with tasks to achieve these objectives [ 43 ]. Limitations and futures avenues Our study has certain limitations. It was conducted within two large organizations in a single country, potentially limiting the generalizability of findings in other countries’ contexts. However, these organizations are considered representative of their respective sectors. Regarding organizational size, our conclusions may not be applicable to small organizations without human resource departments. More recently, Quebec’s bill 59 highlighted the importance of revising health and safety committees for businesses with fewer than 20 employees. Therefore, recommending the involvement of an RTW-C for employees absent for more than one month using the PRATICA dr platform, aligns with these initiatives. While intervention structures may vary depending on national legislation and social security systems, common RTW coordination practices seems to transcend national boundaries [ 24 ]. The training duration recommended for RTW-C typically ranges from two to four days [ 13 ]. In our study, RTW-C training lasted only two days, focusing on PRATICA dr tool usage, and practical guideline content for stakeholders. Given the diverse professional backgrounds of RTW-C personnel, future implementations of PRATICA dr could benefit from supervision or co-development groups to enhance competencies and ensure comprehensive understanding of key issues [ 22 ]. Future research could also delve into identifying essential competencies for effective RTW coordination [ 44 ]. Finally, our study employed a quasi-experimental design with matched participants. Although this method exhibits robustness, particularly when multiple variables are utilized in the pairing, it is strongly recommended for future studies to conduct a randomized controlled trial (RCT). Conclusion Common mental disorders (CMDs) have a significant impact on employees on sick leave, with relapse being common recurrences, carrying substantial public health and economic implications. The web platform PRATICA dr utilized by a Return-to-Work Coordinator (RTW-C) outperformed the standard RTW-C intervention in two large organizations (public and private sectors). The experimental group exhibited positive and significant work outcomes, including an 85-day reduction in sick leave, irrespective of intervention onset, and an 81-day reduction when the intervention began after 2 months of sick leave. Furthermore, no relapses were observed in the experimental group, contrasting with a 13.2% relapse rate in the usual intervention group. These findings are supported by a reduction in clinical symptoms pre- and post-intervention in the experimental group. They underscore the significance of equipping an RTW-C with the addition of a platform that brings together key RTW stakeholders and utilizes validated tools and practical guides. Beyond study limitations, a randomized-controlled trial is warranted, alongside exhaustive assessments of RTW-C competencies. Declarations Ethics approval and consent to participate The study follows the recommendations for research on human subjects as declared in the Helsinki Declaration. Ethical approval for this study was obtained from the research ethics board of the CIUSSS de l'Est-de-l'Île-de-Montréal (#MP-12-2018-1155 and #2018 − 1052). All participants provided informed consent prior to participating in the study. Consent for publication Not applicable. Competing interests: The authors have no conflict of interest to disclose. Competing interests The authors declare that they have no competing interests. Funding This study received funding support from the Research Chair in Mental Health and Work, funded by the Foundation of the Institut en santé mentale de Montréal and the CIUSSS-de-l'Est-de-l'Île-de-Montréal. Author Contribution MC and MMC designed the study with the help of TL, SG, and AP. MC had the main responsibility for the quasi-experimental study from which the employees were recruited. CEG performed the statistical analysis and prepared tables and figures. MC led the writing, with significant input from MMC, TL, SG, AP, and CEG. All authors read and approved the final manuscript. Acknowledgements The authors gratefully acknowledge the individuals who participated in the study, as well as return-to-work coordinators. Availability of data and materials The datasets generated and analysed during the current study are not publicly available. Data are available upon reasonable request. References Gili M, Vicens C, Roca M, Andersen P, McMillan D. Interventions for preventing relapse or recurrence of depression in primary health care settings: A systematic review. Prev Med. 2015;76. https://doi.org/10.1016/j.ypmed.2014.07.035 . Suppl:S16-21. Joyce S, Modini M, Christensen H, Mykletun A, Bryant R, Mitchell PB, et al. Workplace interventions for common mental disorders: a systematic meta-review. Psychol Med. 2016;46:683–97. https://doi.org/10.1017/S0033291715002408 . Axén I, Brämberg E, Vaez M, Lundin A, Bergström G. Interventions for common mental disorders in the occupational health service: a systematic review with a narrative synthesis. Int Arch Occup Environ Health 2020;93. https://doi.org/10.1007/s00420-020-01535-4 . Nigatu YT, Liu Y, Uppal M, McKinney S, Rao S, Gillis K, et al. Interventions for enhancing return to work in individuals with a common mental illness: systematic review and meta-analysis of randomized controlled trials. Psychol Med. 2016;46:3263–74. https://doi.org/10.1017/S0033291716002269 . Stratton E, Lampit A, Choi I, Calvo RA, Harvey SB, Glozier N. Effectiveness of eHealth interventions for reducing mental health conditions in employees: A systematic review and meta-analysis. PLoS ONE. 2017;12:e0189904. https://doi.org/10.1371/journal.pone.0189904 . Nielsen K, Yarker J, Munir F, Bültmann U. IGLOO: An integrated framework for sustainable return to work in workers with common mental disorders. Work Stress. 2018;32:400–17. https://doi.org/10.1080/02678373.2018.1438536 . Dewa CS, Loong D, Trojanowski L, Bonato S. The effectiveness of augmented versus standard individual placement and support programs in terms of employment: a systematic literature review. J Ment Health. 2018;27:174–83. https://doi.org/10.1080/09638237.2017.1322180 . Doran CM, Kinchin I. A review of the economic impact of mental illness. Aust Health Rev. 2019;43:43–8. https://doi.org/10.1071/AH16115 . Dewa CS, Trojanowski L, Joosen MCW, Bonato S. Employer Best Practice Guidelines for the Return to Work of Workers on Mental Disorder-Related Disability Leave: A Systematic Review. Can J Psychiatry. 2016;61:176–85. https://doi.org/10.1177/0706743716632515 . Lebeau M. Valeurs estimées par le Groupe de Connaissance et Surveillance Statistiques (GCSS) de l’IRSST à partir de données provenant de la CSST (2005–2007) 2015. Volker D, Vlasveld MC, Anema JR, Beekman AT, Roijen LH, Brouwers EP, et al. Blended E-health module on return to work embedded in collaborative occupational health care for common mental disorders: design of a cluster randomized controlled trial. Neuropsychiatr Dis Treat. 2013;9:529–37. https://doi.org/10.2147/NDT.S43969 . Venning A, Oswald TK, Stevenson J, Tepper N, Azadi L, Lawn S, et al. Determining what constitutes an effective psychosocial ‘return to work’ intervention: a systematic review and narrative synthesis. BMC Public Health. 2021;21:2164. https://doi.org/10.1186/s12889-021-11898-z . Corbière M, Mazaniello-Chézol M, Lecomte T, Guay S, Panaccio A. Developing a collaborative and sustainable return to work program for employees with common mental disorders: a participatory research with public and private organizations. Disabil Rehabil. 2022;44:5199–211. https://doi.org/10.1080/09638288.2021.1931481 . Corbière M, Mazaniello-Chézol M, Bastien M-F, Wathieu E, Bouchard R, Panaccio A, et al. Stakeholders’ Role and Actions in the Return-to-Work Process of Workers on Sick-Leave Due to Common Mental Disorders: A Scoping Review. J Occup Rehabil. 2020;30:381–419. https://doi.org/10.1007/s10926-019-09861-2 . Franche R-L, Baril R, Shaw W, Nicholas M, Loisel P. Workplace-Based Return-to-Work Interventions: Optimizing the Role of Stakeholders in Implementation and Research. J Occup Rehabil. 2005;15:525–42. https://doi.org/10.1007/s10926-005-8032-1 . Tikka C, Verbeek J, Hoving JL, Kunz R. Evidence-informed decision about (de-)implementing return-to-work coordination to reduce sick leave: a case study. Health Res Policy Syst. 2022;20:19. https://doi.org/10.1186/s12961-022-00823-4 . Ståhl C. Implementing interorganizational cooperation in labour market reintegration: a case study. J Occup Rehabil. 2012;22:209–19. https://doi.org/10.1007/s10926-011-9337-x . Andersen MF, Nielsen KM, Brinkmann S. Meta-synthesis of qualitative research on return to work among employees with common mental disorders. Scand J Work Environ Health. 2012;38:93–104. https://doi.org/10.5271/sjweh.3257 . Skarpaas LS, Haveraaen LA, Småstuen MC, Shaw WS, Aas RW. Horizontal return to work coordination was more common in RTW programs than the recommended vertical coordination. The Rapid-RTW cohort study. BMC Health Serv Res 2019;19. https://doi.org/10.1186/s12913-019-4607-y . Skarpaas LS, Haveraaen LA, Småstuen MC, Shaw WS, Aas RW. The association between having a coordinator and return to work: the rapid-return-to-work cohort study. BMJ Open. 2019;9:e024597. https://doi.org/10.1136/bmjopen-2018-024597 . Svärd V, Berglund E, Björk Brämberg E, Gustafsson N, Engblom M, Friberg E. Coordinators in the return-to-work process: Mapping their work models. PLoS ONE. 2023;18:e0290021. https://doi.org/10.1371/journal.pone.0290021 . Holmlund L, Hellman T, Engblom M, Kwak L, Sandman L, Törnkvist L, et al. Coordination of return-to-work for employees on sick leave due to common mental disorders: facilitators and barriers. Disabil Rehabil. 2022;44:3113–21. https://doi.org/10.1080/09638288.2020.1855263 . Vogel N, Schandelmaier S, Zumbrunn T, Ebrahim S, de Boer WE, Busse JW et al. Return-to-work coordination programmes for improving return to work in workers on sick leave. Cochrane Database Syst Reviews 2017;2017. https://doi.org/10.1002/14651858.CD011618.pub2 . Kausto J, Oksanen T, Koskinen A, Pentti J, Mattila-Holappa P, Kaila-Kangas L, et al. Return to Work’ Coordinator Model and Work Participation of Employees: A Natural Intervention Study in Finland. J Occup Rehabil. 2021;31:831–9. https://doi.org/10.1007/s10926-021-09970-x . Eskilsson T, Norlund S, Lehti A, Wiklund M. Enhanced Capacity to Act: Managers’ Perspectives When Participating in a Dialogue-Based Workplace Intervention for Employee Return to Work. J Occup Rehabil. 2021;31:263–74. https://doi.org/10.1007/s10926-020-09914-x . Volker D, Zijlstra-Vlasveld MC, van der Brouwers EPM. Process Evaluation of a Blended Web-Based Intervention on Return to Work for Sick-Listed Employees with Common Mental Health Problems in the Occupational Health Setting. J Occup Rehabil. 2017;27:186–94. https://doi.org/10.1007/s10926-016-9643-4 . Strudwick G, Impey D, Torous J, Krausz RM, Wiljer D, Advancing. E-Mental Health in Canada: Report From a Multistakeholder Meeting. JMIR Ment Health. 2020;7:e19360. https://doi.org/10.2196/19360 . Engdahl P, Svedberg P, Lexén A, Bejerholm U. Role of a Digital Return-To-Work Solution for Individuals With Common Mental Disorders: Qualitative Study of the Perspectives of Three Stakeholder Groups. JMIR Form Res. 2020;4:e15625. https://doi.org/10.2196/15625 . Phillips EA, Gordeev VS, Schreyögg J. Effectiveness of occupational e-mental health interventions: a systematic review and meta-analysis of randomized controlled trials. Scand J Work Environ Health. 2019;45:560–76. https://doi.org/10.5271/sjweh.3839 . Lecomte T, Potvin S, Corbière M, Guay S, Samson C, Cloutier B, et al. Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses. JMIR Mhealth Uhealth. 2020;8:e17458. https://doi.org/10.2196/17458 . Kausto J, Pentti J, Oksanen T, Virta LJ, Virtanen M, Kivimäki M, et al. Length of sickness absence and sustained return-to-work in mental disorders and musculoskeletal diseases: a cohort study of public sector employees. Scand J Work Environ Health. 2017;43:358–66. https://doi.org/10.5271/sjweh.3643 . Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13. https://doi.org/10.1046/j.1525-1497.2001.016009606.x . Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092–7. https://doi.org/10.1001/archinte.166.10.1092 . Furukawa TA. Assessment of mood: guides for clinicians. J Psychosom Res. 2010;68:581–9. https://doi.org/10.1016/j.jpsychores.2009.05.003 . Nieuwenhuijsen K, Verbeek JH, Neumeyer-Gromen A, Verhoeven AC, Bültmann U, Faber B. Interventions to improve return to work in depressed people. Cochrane Database Syst Rev. 2020;10:CD006237. https://doi.org/10.1002/14651858.CD006237.pub4 . Rodriguez-Seijas C, Li JJ, Balling C, Brandes C, Bernat E, Boness CL, et al. Diversity and the Hierarchical Taxonomy of Psychopathology (HiTOP). Nat Reviews Psychol. 2023;2:483–95. https://doi.org/10.1038/s44159-023-00200-0 . R Core Team. A Language and Environment for Statistical Computing_. R Foundation for Statistical Computing; 2023. Therneau T. _A Package for Survival Analysis in R_. R package version 3.5-7, 2023. Cox DR. Regression Models and Life-Tables. Journal of the Royal Statistical Society: Series B (Methodological). 1972;34:187–202. https://doi.org/10.1111/j.2517-6161.1972.tb00899.x . Volker D, Zijlstra-Vlasveld MC, Anema JR, Beekman AT, Brouwers EP, Emons WH, et al. Effectiveness of a blended web-based intervention on return to work for sick-listed employees with common mental disorders: results of a cluster randomized controlled trial. J Med Internet Res. 2015;17:e116. https://doi.org/10.2196/jmir.4097 . Dewa CS, Hoch JS, Loong D, Trojanowski L, Bonato S. Evidence for the Cost-Effectiveness of Return-to-Work Interventions for Mental Illness Related Sickness Absences: A Systematic Literature Review. J Occup Rehabil. 2021;31:26–40. https://doi.org/10.1007/s10926-020-09904-z . Dol M, Varatharajan S, Neiterman E, McKnight E, Crouch M, McDonald E, et al. Systematic Review of the Impact on Return to Work of Return-to-Work Coordinators. J Occup Rehabil. 2021;31:675–98. https://doi.org/10.1007/s10926-021-09975-6 . Corbière M, Villotti P, Berbiche D, Lecomte T. Predictors of job tenure for people with a severe mental illness, enrolled in supported employment programs. Psychiatr Rehabil J. 2023. https://doi.org/10.1037/prj0000589 . MacEachen E, McDonald E, Neiterman E, McKnight E, Malachowski C, Crouch M, et al. Return to Work for Mental Ill-Health: A Scoping Review Exploring the Impact and Role of Return-to-Work Coordinators. J Occup Rehabil. 2020;30:455–65. https://doi.org/10.1007/s10926-020-09873-3 . Additional Declarations No competing interests reported. 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Corbière","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIiWNgGAWjYHACNoYEOLuCdC1niNUCB4xtRKjnb+999uBBxT05BrHDzz78nHdYtn/aAcYPP/BokThz3Nwg4UyxMYN0mvHM3m2HjWfcTmCW7MGjxUAijU0isS0hsUE6wZiZcdvhxIbbCWwMPAS1/Euob5BO/8zMOOdw4nygFsY/BLU0JCQwSOcAbWk4nLgBqIUZny0SZ46xGyQcSzBsk84pZuw5lm688XZis7QMHi387W1sD3/UJMjzS6dvZvhRYy0773bywY9v8GiBA1jsMDaAEEmAVPWjYBSMglEwAgAA5BpJJQSoelQAAAAASUVORK5CYII=","orcid":"","institution":"University of Quebec in Montreal","correspondingAuthor":true,"prefix":"","firstName":"Marc","middleName":"","lastName":"Corbière","suffix":""},{"id":282145161,"identity":"c9a5f139-956d-4567-9446-e9e76200b22b","order_by":1,"name":"Maud Mazaniello-Chézol","email":"","orcid":"","institution":"McGill University","correspondingAuthor":false,"prefix":"","firstName":"Maud","middleName":"","lastName":"Mazaniello-Chézol","suffix":""},{"id":282145162,"identity":"6c1e5666-fd7f-4a5a-9aee-262eb79d8941","order_by":2,"name":"Tania Lecomte","email":"","orcid":"","institution":"University of Montreal","correspondingAuthor":false,"prefix":"","firstName":"Tania","middleName":"","lastName":"Lecomte","suffix":""},{"id":282145163,"identity":"83198700-5d9e-4810-b2f0-d0a98893bff5","order_by":3,"name":"Stéphane Guay","email":"","orcid":"","institution":"University of Montreal","correspondingAuthor":false,"prefix":"","firstName":"Stéphane","middleName":"","lastName":"Guay","suffix":""},{"id":282145164,"identity":"6352d03a-6007-45bd-be99-211042f2d482","order_by":4,"name":"Alexandra Panaccio","email":"","orcid":"","institution":"Concordia University","correspondingAuthor":false,"prefix":"","firstName":"Alexandra","middleName":"","lastName":"Panaccio","suffix":""},{"id":282145165,"identity":"f27afb97-7398-4b8e-97ad-c88a4654f9a6","order_by":5,"name":"Charles-Édouard Giguère","email":"","orcid":"","institution":"Centre de recherche de l'lnstitut universitaire en santé mentale de Montréal","correspondingAuthor":false,"prefix":"","firstName":"Charles-Édouard","middleName":"","lastName":"Giguère","suffix":""}],"badges":[],"createdAt":"2024-03-20 14:42:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4137951/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4137951/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-025-21716-5","type":"published","date":"2025-02-18T15:58:04+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":53418745,"identity":"b5f93811-17dd-4ccc-9586-d42dd6d497ca","added_by":"auto","created_at":"2024-03-25 18:09:42","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":228396,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier survival curve for time to RTW\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4137951/v1/8e7afb3acc1cbef36325e418.jpeg"},{"id":53418744,"identity":"989b33c8-9f34-4950-b269-89d67b30197b","added_by":"auto","created_at":"2024-03-25 18:09:42","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":40964,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier survival curve for time to RTW with rehabilitation care duration less than 60 days\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4137951/v1/725083f64dbae1c967360ed6.png"},{"id":53418747,"identity":"454514e5-9d20-4069-baf8-4a99b1ed25df","added_by":"auto","created_at":"2024-03-25 18:09:42","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":37547,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier survival curve for time to RTW with rehabilitation care duration more than 60 days\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-4137951/v1/511ab355add3d05ed8e2b49f.png"},{"id":53419980,"identity":"0d014aec-115e-4e7c-84b1-eedfc797b0a8","added_by":"auto","created_at":"2024-03-25 18:17:42","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":237006,"visible":true,"origin":"","legend":"\u003cp\u003eMeans of depressive symptoms (PHQ-9) and anxiety symptoms (GAD-7) according to mixed linear models\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4137951/v1/ee327e2961714dcc260c5502.jpeg"},{"id":77052693,"identity":"ccc823c0-fc4e-4af7-9e1c-2305eb80f65e","added_by":"auto","created_at":"2025-02-24 16:23:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1288930,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4137951/v1/42114237-cd4b-4c2c-a815-43ef3c554f72.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Web-Enhanced Return-to-Work Coordination for employees with common mental disorders: Reduction of sick leave duration and relapse","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCommon mental disorders (CMDs) are highly prevalent in workplace settings, and have become a significant public health challenge [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. CMDs, including depressive and anxiety disorders, along with adjustment disorders, account for 30\u0026ndash;50% of reasons for workplace absenteeism [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Recurrence rates among returning employees range from 20\u0026ndash;30% [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], regardless of the specific CMD and time evaluation, with projected costs reaching \u003cspan\u003e$\u003c/span\u003e3\u0026ndash;6 trillion by 2030 [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In Canada, CMDs incur an estimated \u003cspan\u003e$\u003c/span\u003e51\u0026nbsp;billion in costs, including medical expenses, and productivity loss [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In the province of Qu\u0026eacute;bec, the average cost is \u003cspan\u003e$\u003c/span\u003e125,000 for employee relapse compared to \u003cspan\u003e$\u003c/span\u003e69 000 for those with CMDs without relapse [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Absences due to CMDs impact individual\u0026rsquo;s professional identity, skills confidence, and exacerbate symptoms, affecting work environments [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Stakeholders including employers, HR professionals, managers, and health professionals across diverse sectors must collaborate to develop strategies to reduce sick leave duration and prevent relapses upon return to work [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGrounded in the literature and tailored for large Canadian organisations, both public and private, the Return to Work (RTW) process is structured into three phases with 10 milestones [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Phase 1 involves initiating sickness absence management, Phase 2 focuses on treatment rehabilitation and RTW preparation, and Phase 3 encompasses gradual RTW and follow-up. The RTW process entails a series of interactions and interventions conducted by various stakeholders within diverse environments and systems, such as work (e.g., employer, manager, unions), health (e.g., family physician, rehabilitation professionals), and insurance (e.g., insurer) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Improving communication and collaboration among these stakeholders is crucial for reducing sick leave duration and preventing relapses [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. As the responsibility for the RTW process is distributed among multiple stakeholders, there is a risk of responsibility fragmentation and gaps in orchestrating actions, leading to efficiency and quality issues [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. A meta-synthesis of qualitative research on mental health and work issues highlights a lack of coordination among stakeholders from the three systems mentioned above [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Efforts towards building more integrated healthcare systems internationally aim to address these challenges [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMany Scandinavian countries, particularly Finland, Norway, Sweden, and Denmark have implemented RTW Coordinators (RTW-C) to enhance communication and collaboration among stakeholders involved in the RTW process [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Timely RTW is crucial to prevent permanent work disability, and RTW-C provision aims to improve program timing and planning [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Despite several literature reviews and meta-analyses of randomised controlled trials, there is ongoing debate about the impact of the RTW-C [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Some studies suggest that the RTW-C model, or certain components of the model, may reduce the duration of work disability, while others argue that offering RTW coordination has no discernible benefits compared to usual practice [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Based on the Cochrane review by Vogel et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], the uncertainty in evidence regarding the benefits of RTW coordination programs may be attributed to the low quality of research and variations in the organization and implementation of these programs. Among the studies included in Vogel et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], only two focused exclusively on CMDs, and there is no uniform definition of RTW coordination programs across studies. It might be possible that the coordination model, where the RTW-C is placed in specialist healthcare services without real possibilities to coordinate and accommodate at the workplace, does not facilitate RTW [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the literature, coordination among RTW stakeholders is described as vertical, spanning different levels and institutions, and horizontal, occurring within one level or service [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Dialogue mechanisms between employees and managers [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] or occupational physicians [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] in Europe positively impact RTW. Despite numerous stakeholders playing crucial roles throughout the RTW process, coordination often involves exclusive dyadic relationships [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Timing of intervention and systematic, centralized information are also critical. Online mental health technologies offer a solution to access issues in mental health services and can enhance coordination among stakeholders [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Transforming effective RTW interventions into digital solutions can increase accessibility regardless of location and time [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Furthermore, a recent meta-analysis has been conducted on online interventions in the field of mental health and work [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], along with a meta-review of mobile applications deployed in mental health [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] indicating no application or web platform facilitating RTW for CMDs. Together, the applications identified in these meta-analyses, meta-review, and more recent studies do not address the issue of coordinating actions among multiple RTW stakeholders. They generally focus on a single user or a dyad (e.g., the occupational physician and the employee on sick leave).\u003c/p\u003e \u003cp\u003eTo fill the existing gap in evidence-based digital support for sustainable RTW for individuals with CMDs and RTW stakeholders, this study aimed to implement a web application tailored for this purpose. The web application, named PRATICA\u003csup\u003edr\u003c/sup\u003e, is specifically designed for employees with CMD and RTW stakeholders, including RTW-C, General Practitioners (GPs), Managers, and Occupational and Health Professionals. Following Vogel et al.\u0026rsquo;s [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] recommendation, we not only track RTW occurrences but also monitor relapses into sick leave, providing a detailed intervention description. In our quasi-experimental study, we evaluated the effectiveness RTW-C assisted by PRATICA\u003csup\u003edr\u003c/sup\u003e, compared to a usual (control) group receiving standard RTW-C support without PRATICA\u003csup\u003edr\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOur hypotheses were as follows:\u003c/p\u003e \u003cp\u003eIntergroup Comparisons (experimental vs control group):\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eHyp1: PRATICA\u003csup\u003edr\u003c/sup\u003e + RTW-C participants will have shorter sick leave duration compared to the usual intervention (only RTW-C).\u003c/p\u003e\u003cp\u003eHyp2: PRATICA\u003csup\u003edr\u003c/sup\u003e + RTW-C participants will have fewer relapses during follow-up than those in the usual intervention group.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eIntragroup Analysis (experimental group only):\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eHyp3: Participants in the PRATICA\u003csup\u003edr\u003c/sup\u003e group will observe a reduction in depressive and anxious symptoms over time.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Participant Recruitment\u003c/h2\u003e \u003cp\u003eFor this quasi-experimental preliminary study, participants were recruited into the experimental condition, or to the control condition. Inclusion criteria for both groups were: 1) a documented sick-leave prescription with a diagnosis of a CMD (depression, anxiety and adjustment disorders), 2) the ability to communicate in French, and 3) receiving services from a RTW-C in a participating clinic (from the private or public sector). For the control condition, the criteria were the same, but with added matching on key variables (see below). We recruited 40 participants for the experimental group by inviting them to take part in the PRATICA\u003csup\u003edr\u003c/sup\u003e group; three were excluded at baseline if they no longer fit inclusion criteria (i.e. not currently returning to work due to physical ailment). To match, we recruited 37 participants to take part in the control condition. Additionally, three from the control group were later excluded for reasons similar to those in the experimental group such as undergoing surgery or pregnancy. Both conditions had equal distribution of 50% from a large public health organization (n\u0026thinsp;=\u0026thinsp;35) and 50% from a large private financial organization (n\u0026thinsp;=\u0026thinsp;35).\u003c/p\u003e \u003cp\u003eMatching criteria included demographic and clinical characteristics, employment-related factors (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Given that all participants in the experimental condition had recently returned to work after a sick leave due to common mental illness, this was also a matching criterion. Fisher exact tests showed no significant differences between groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Duration of sick leave and relapses were assessed three months after RTW for both groups. Relapse is defined as being for a minimum of 5 working days due to reasons associated with a CMD. Following the three phases of the RTW process and applicable only to the experimental group, clinical measures (depressive and anxious symptoms) were administered at baseline (pre-intervention, phase 1), intervention (phase 2), during therapeutic RTW (phase 3), as well as 1-month follow-up (post-therapeutic RTW) and 3-month follow-up (post-therapeutic RTW). Sustainable RTW is defined as 30 days of work following the sickness benefit period [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic information for experimental and group controls according to the sector of activity\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003ePublic sector\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003ePrivate sector\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExperimental\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eExperimental\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;45 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;45 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdjustment disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.50\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of employment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003cp\u003eSocial worker\u003c/p\u003e \u003cp\u003eBeneficiary caregiver\u003c/p\u003e \u003cp\u003eSupport staff\u003c/p\u003e \u003cp\u003eAdministrative officer\u003c/p\u003e \u003cp\u003eCounsellor\u003c/p\u003e \u003cp\u003eDirector\u003c/p\u003e \u003cp\u003eAnalyst\u003c/p\u003e \u003cp\u003eCustomer service\u003c/p\u003e \u003cp\u003eTechnical support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e10\u003c/p\u003e \u003cp\u003e5\u003c/p\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e5\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.47\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e0.27\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eIntervention and procedures\u003c/h2\u003e \u003cp\u003eParticipants in the experimental group were provided access to the PRATICA\u003csup\u003edr\u003c/sup\u003e application, facilitated by the research team. PRATICA\u003csup\u003edr\u003c/sup\u003e is a technology-driven solution developed from evidence-based interventions with the aim of enhancing collaboration between RTW stakeholders and providing systematic support throughout the RTW process. Key features of PRATICA\u003csup\u003edr\u003c/sup\u003e include:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e1) Facilitation of collaboration among multiple RTW stakeholders across healthcare, enterprise, and insurance sectors, with a focus on the RTW-C,\u003c/p\u003e\u003cp\u003e2) User-friendly interface tailored for employees on sick leave and RTW stakeholders,\u003c/p\u003e\u003cp\u003e3) Integration of each stakeholder\u0026rsquo;s action into the sick leave employee\u0026rsquo;s RTW process,\u003c/p\u003e\u003cp\u003e4) Sequential process aligned with the three phases of the RTW,\u003c/p\u003e\u003cp\u003e5) Integration of organizational-specific best practice guides for RTW stakeholders,\u003c/p\u003e\u003cp\u003e6) Inclusion of validated tools covering various topics such as RTW barriers, self-efficacy, workplace accommodations, and clinical symptoms,\u003c/p\u003e\u003cp\u003e7) Centralization of information through data collection,\u003c/p\u003e\u003cp\u003e8) Capacity to handle large volumes of cloud-based data, ensuring accessibility and adaptability for tracking employee progress,\u003c/p\u003e\u003cp\u003e9) Assurance of confidentiality through encrypted personal data storage.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eBefore the intervention, the research coordinator thoroughly explained the research protocol and the sequential phases of the RTW program integrated into the application to each participant and RTW-C. Each participant was assigned a dedicated set of stakeholders involved in their RTW process, including a RTW-C, healthcare provider (e.g., family physician or nurse practitioner), rehabilitation professional (e.g., occupational therapist or physiotherapist), manager, and insurer. Upon obtaining informed consent from the participant, the RTW-C initiated contact with these stakeholders, granting them access to the application via email communication. The roles and responsibilities of each stakeholder were clearly communicated, with a focus on the availability of best practice guides embedded within the application. Practical guides within the application detailed the expected roles and actions of all stakeholders as recommended in the literature [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Upon initial login to the application, participants were prompted to provide electronic consent, signifying the start of the PRATICA\u003csup\u003edr\u003c/sup\u003e intervention. The application followed a predetermined workflow that incorporated evidence-based best practices [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] and the RTW program developed by the research team [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This structured approach ensured uniformity and adherence to established guidelines throughout the intervention. Ethical approval for this study was obtained from the research ethics board of the CIUSSS de l'Est-de-l'\u0026Icirc;le-de-Montr\u0026eacute;al (#MP-12-2018-1155 and #2018\u0026thinsp;\u0026minus;\u0026thinsp;1052).\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003eDepressive and anxiety symptoms\u003c/h2\u003e \u003cp\u003eTo assess CMD symptoms for the participants in the experimental group, we utilized the Patient Health Questionnaire (PHQ-9) [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] and the Generalized Anxiety Disorder Scale (GAD-7) [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The PHQ-9 includes 9 items evaluating depressive symptoms, while the GAD-7 consists of seven items assessing anxiety symptoms. Both scales employ a 4-level Likert scale (0\u0026thinsp;=\u0026thinsp;never, 1\u0026thinsp;=\u0026thinsp;several days, 2\u0026thinsp;=\u0026thinsp;more than half the time, 3\u0026thinsp;=\u0026thinsp;almost every day) for participant responses. Total scores are calculated by summing the responses, with specific scores ranges indicating varying levels of depression or anxiety severity. For the PHQ-9, reliability is excellent (α\u0026thinsp;=\u0026thinsp;0.89) and test-retest reliability over a 7-day period is also high (ICC\u0026thinsp;=\u0026thinsp;0.92) [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Similarly, the GAD-7 demonstrates excellent reliability (α\u0026thinsp;=\u0026thinsp;0.92) and good test-retest reliability within a week (ICC\u0026thinsp;=\u0026thinsp;0.83) [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. A score of \u0026ge;\u0026thinsp;10 on both scales, typically indicates moderate intensity of depression or generalized anxiety symptoms.\u003c/p\u003e \u003cp\u003eThese measures were administered at each assessment time point including baseline or pre-intervention, post intervention, therapeutic RTW, 1-month and 3-month follow-ups. Comparisons between the experimental groups (private and public organisations) at the baseline revealed no significant differences in depressive and anxious symptoms (p-values of 0,58 and 0,88, respectively), enabling subsequent analyses combining both groups. Interestingly, as Nieuwenhuijsen et al. [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] demonstrated, the distinction between depressive and other disorders such as anxiety disorders becomes less relevant as new insights are emerging based on transdiagnostic psychopathology (see HiTop- [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]). This approach involves investigating the importance and connections of individual symptoms rather than disorders.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eAnalyses\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using R [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] and the survival package [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. \u003cem\u003eSurvival analyses\u003c/em\u003e were employed for H1 and H2. Cox regression analysis [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] was used to estimate the time until event occurrence, and the results were presented in terms of hazard ratios (HRs). As previously mentioned, all participants, both in experimental and control groups, returned to work. In the model, the \u003cem\u003esurvival time\u003c/em\u003e variable was \u0026ldquo;the duration of sick leave\u0026rdquo; measured in days. A Kaplan\u0026ndash;Meier survival curve was utilized to estimate cumulative survival probabilities and assess RTW patterns over time. Additional analyses were conducted to assess the effect of the onset of the rehabilitation care on sick leave duration in both experimental and control groups. The median duration of the onset of the rehabilitation care (i.e. duration until the RTW-C assumes the responsibility after the onset of sick leave) was approximately 2 months (60 days), used as a threshold for analyses (\u0026lt;\u0026thinsp;60 days vs. \u0026ge;60 days). H2 was tested using a Fischer exact test due to the small sample size, determining differences between the experimental and control groups. To test hypothesis H3, regarding mean differences over time, mixed linear models were estimated.\u003c/p\u003e \u003cp\u003eThe models were adjusted using the following formula:\u003c/p\u003e \u003cp\u003e \u003cspan class=\"InlineEquation\"\u003e \u003cspan class=\"mathinline\"\u003e\\({y}_{it}={\\beta }_{0i}+ {\\beta }_{1t}+ {ϵ}_{it}\\)\u003c/span\u003e \u003c/span\u003e \u003cspan class=\"InlineEquation\"\u003e \u003cspan class=\"mathinline\"\u003e\\({\\beta }_{0i}={\\beta }_{0}+ {\\xi }_{i}\\)\u003c/span\u003e \u003c/span\u003e \u003c/p\u003e \u003cp\u003eWhere \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({y}_{it}\\)\u003c/span\u003e\u003c/span\u003e represents the dependent variable of subject \u003cem\u003ei\u003c/em\u003e at time \u003cem\u003et\u003c/em\u003e. \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({\\beta }_{0i}\\)\u003c/span\u003e\u003c/span\u003e represents a random coefficient comprising a fixed part \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({\\beta }_{0}\\)\u003c/span\u003e\u003c/span\u003e and a random effect \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({\\xi }_{i}\\)\u003c/span\u003e\u003c/span\u003e. \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({\\beta }_{1t}\\)\u003c/span\u003e\u003c/span\u003e represents the time adjustment (2, \u0026hellip;, 5) relative to time 1 (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({\\beta }_{11}=0\\)\u003c/span\u003e\u003c/span\u003e). Finally, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({ϵ}_{it}\\)\u003c/span\u003e\u003c/span\u003e is a residual term for which we assume that the variance is a function of time (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({ϵ}_{it}\\sim \\text{N}\\left(0,{\\sigma }_{t}^{2}\\right)\\)\u003c/span\u003e\u003c/span\u003e \u0026ndash; variance heteroskedastic). This model was constructed using the nlme package.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents a graphical depiction of the Kaplan\u0026ndash;Meier results for sick leave duration in both experimental and control groups. The survival curve indicates that 50% of employees in the experimental group returned to work within 215 (sd\u0026thinsp;=\u0026thinsp;84) days, while it took 300 (sd\u0026thinsp;=\u0026thinsp;139) days for the control group. The median sick leave duration was 7.2 months for the experimental group and 10 months for the control group, showing a nearly 3 months (or 85 days) difference in favor of the experimental group (HR\u0026thinsp;=\u0026thinsp;2.5; p\u0026thinsp;\u0026lt;\u0026thinsp;.001).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigures \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e depict Kaplan\u0026ndash;Meier estimates for sick leave duration in both groups, categorized by duration of the rehabilitation care following the onset of sick leave (\u0026lt;\u0026thinsp;60 days vs. \u0026ge;60 days). Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows similar median sick leave durations (5.3 months) when the period of time between the start of sick leave and the start of the rehabilitation care was less than 2 months after the sick leave (HR\u0026thinsp;=\u0026thinsp;0,87, p\u0026thinsp;=\u0026thinsp;0,80). In Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, the experimental group had a median sick leave duration of 7.7 months (231 days; sd\u0026thinsp;=\u0026thinsp;62) compared to 10,4 months (312 days; sd\u0026thinsp;=\u0026thinsp;130) for the control group (HR\u0026thinsp;=\u0026thinsp;3,44, p\u0026thinsp;\u0026lt;\u0026thinsp;0,001) when the period of time between the start of the rehabilitation care exceeded 2 months. Overall, the use of PRATICA\u003csup\u003edr\u003c/sup\u003e by the RTW-C significantly reduced sick leave duration, particularly when rehabilitation care duration exceeded 2 months.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eRegarding relapses, a significant difference in relapse rates was found between the experimental and control groups (p\u0026thinsp;=\u0026thinsp;0.045) based on a Fisher exact test. In the control group, 4 individuals (13,2%) experienced relapses within 3 months after RTW, while no relapses were observed in the experimental group.\u003c/p\u003e \u003cp\u003eIn terms of clinical symptoms within the experimental group (private and public), significant mean differences over time were observed, particularly for depressive symptoms between T0 and T1 (p\u0026thinsp;=\u0026thinsp;0,012) and between T2 and T3 (p\u0026thinsp;=\u0026thinsp;0,038) (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Similarly, for anxiety symptoms (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), significant differences were noted between T0 and T1 (p\u0026thinsp;=\u0026thinsp;0,045) and between T2 and T3 (p\u0026thinsp;=\u0026thinsp;0,002). Individuals exhibited clinically anxious and depressive scores at T0 (close to 10), whereas during therapeutic RTW (T3), scores dropped below 5, indicating minimal or no clinical symptoms upon reintegrating into their work environment (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eMobile applications and web platforms are increasingly being used for self-management of CMDs; however, there is a dearth of available eHealth applications providing evidence-based digital support for individuals with CMDs upon their RTW. Furthermore, other RTW stakeholders, such as managers and health professionals, are inconsistently integrated, sometimes only with dyad stakeholders [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The RTW-C has emerged as a key player, tasked with orchestrating all actions involving RTW stakeholders stemming from various systems. Research should not only focus on people returning to work (RTW) but also on sustainable RTW, examining how well individuals can remain at work post-sick leave. This is vital due to the challenges many workers encounter in maintaining work following RTW.\u003c/p\u003e \u003cp\u003eThis quasi-experimental study compared the use of the PRATICA\u003csup\u003edr\u003c/sup\u003e web platform by a RTW-C to the usual intervention of a RTW-C, on work outcomes such as duration of absence and relapses after 3 months following the RTW. Clinical variables were systematically evaluated for the experimental group only, to document their evolution over time, from the beginning of the intervention up to 3 months after the RTW. Results revealed significantly shorter sick leave duration and fewer relapses in the experimental group compared to the control group. Specifically, the average absence duration was 85 days shorter in the experimental group. This difference was found when the RTW-C intervention (rehabilitation care) began 2 months after the onset of sick leave. Relapses, occurring only in the control group (13.2%), were evenly distributed before and after the two-month of the RTW-C intervention without the use of PRATICA\u003csup\u003edr\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn their systematic review and meta-analysis of randomized controlled trials (RCTs) investigating interventions for CMDs and RTW, Nigatu et al. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] reported an average sick-leave duration until RTW ranging from 151 to 165 days for intervention and control groups, respectively. The mean difference was approximately 13 days in favor of the experimental group, indicating a low effect size. Our study aligns with these findings, particularly when the RTW-C starts rehabilitation care within two months of absence. Specifically, both experimental and control groups in our study had an average absence duration of 159\u0026ndash;160 days. Our study provides nuanced insights, demonstrating that when RTW-C intervention begins two months or more after the first day of absence, sick-leave duration is longer: 231 days for the experimental group and 312 days for the control group, with an 81-day advantage favoring the experimental group.\u003c/p\u003e \u003cp\u003eNigatu et al. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] suggested that even a 13-day difference in sick leave duration could have significant economic implications, leading to substantial savings in healthcare and employment costs at the population level. Tikka et al. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] supported this idea, highlighting that a mere 5-day reduction in cumulative sick leave with RTW coordination could save \u0026euro;790 per person in Finland compared to usual care. In Finland and other Scandinavian countries, RTW-C is a governmental measure, with results indicating the benefit of short sick leave durations and recommending the use of RTW-C. Our study, incorporating RTW-C in both experimental and control groups, suggests that the addition of PRATICA\u003csup\u003edr\u003c/sup\u003e, a web platform guiding RTW with validated tools and systematic coordination with stakeholders, could result in significant cost savings.\u003c/p\u003e \u003cp\u003eRelapse rates in CMDs post-RTW have been highlighted as significant as RTW itself in the literature. Nielsen et al. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] reported recurrence rates among returning employees ranging from 20\u0026ndash;30%, irrespective of the specific CMD or evaluation timing. Consistent with these findings, our study found a 13.2% relapse rate (n\u0026thinsp;=\u0026thinsp;4) within three months post-RTW, with no relapses observed in the experimental group. Economically, a CMD relapse after RTW incurs significant costs, with a total of 340,000 euros for four employees experiencing relapses, equivalent to \u003cspan\u003e$\u003c/span\u003e125,000 each in Quebec (or 85,000 euros). The use of PRATICA\u003csup\u003edr\u003c/sup\u003e appears to mitigate relapse risks, reinforcing sustainable RTW and cost-savings efforts.\u003c/p\u003e \u003cp\u003eRelapses were observed not only in employees receiving intervention after 2 months of sick leave, but also in those with more prompt RTW-C intervention (\u0026lt;\u0026thinsp;2 months). This suggests that PRATICA\u003csup\u003edr\u003c/sup\u003e may effectively prevent relapses at any point in the RTW-C intervention. Additionally, the absence of relapses in the experimental group is noteworthy, along with the significant decrease in depressive and anxious symptoms over time. Despite initial moderate to severe symptoms, employees gradually RTW exhibited minimal or very mild symptoms, with stabilization observed during the 3-month follow-up. This stabilization may help mitigate the risk of relapses.\u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eClinical implications\u003c/h2\u003e \u003cp\u003eThe findings suggest that a web platform coupled with a RTW-C intervention decreases the duration of absence in employees with CMDs. Employing a low-intensity RTW intervention using PRATICA\u003csup\u003edr\u003c/sup\u003e, before two months of absence appears a suitable strategy. However, relapses could occur two months prior to the utilization of PRATICA\u003csup\u003edr\u003c/sup\u003e. Therefore, initiating RTW-C intervention\u0026thinsp;+\u0026thinsp;PRATICA\u003csup\u003edr\u003c/sup\u003e from the first month of absence might be even better. Participants who had recovered no longer felt the need to engage with an application such as PRATICA\u003csup\u003edr\u003c/sup\u003e and incomplete questionnaires [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. For such cases, a short period after the onset of sick leave might suffice for spontaneous remission. One month or 30 days is suggested as an acceptable timeframe for the initial intervention, aligning with existing research [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study also emphasizes the presence of a well-equipped RTW-C, especially for absences exceeding two months. PRATICA\u003csup\u003edr\u003c/sup\u003e has the advantage of incorporating the necessary guidelines for the RTW process, along with tools to guide RTW-C intervention, including symptom assessment, workplace accommodations, and perceived obstacles to returning to work. Additionally, PRATICA\u003csup\u003edr\u003c/sup\u003e outlines the roles and actions that each stakeholder should adopt in the form of practical guides. These tools and guidelines facilitate better support for employees by the RTW-C in the context of work rehabilitation. Furthermore, other stakeholders accessing PRATICA\u003csup\u003edr\u003c/sup\u003e can real-time access relevant information due to centralized data, with medical information available exclusively to healthcare professionals.\u003c/p\u003e \u003cp\u003eTraining on these elements becomes crucial for effective RTW-C support. Dol et al. [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], in their systematic review, conducted evidence synthesis (moderate to strong) regarding the best intervention components when there is an RTW-C, such as training RTWCs, developing an RTW plan, ergonomic worksite evaluation, communication between different stakeholders, and identifying barriers and facilitators to RTW. Dol et al. [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e] also discussed the stressfulness of interactions with the RTW-C as a major contributing factor to positive RTW outcomes in their review. As for individuals with severe mental disorders, the working alliance inventory could be an interesting asset for sustainable RTW for people with CMDs followed by a RTW-C, assessing the dyadic interaction between the RTW-C and the employee, their mutual agreement on recovery goals, and sustainable RTW, along with tasks to achieve these objectives [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and futures avenues\u003c/h2\u003e \u003cp\u003eOur study has certain limitations. It was conducted within two large organizations in a single country, potentially limiting the generalizability of findings in other countries\u0026rsquo; contexts. However, these organizations are considered representative of their respective sectors. Regarding organizational size, our conclusions may not be applicable to small organizations without human resource departments. More recently, Quebec\u0026rsquo;s bill 59 highlighted the importance of revising health and safety committees for businesses with fewer than 20 employees. Therefore, recommending the involvement of an RTW-C for employees absent for more than one month using the PRATICA\u003csup\u003edr\u003c/sup\u003e platform, aligns with these initiatives. While intervention structures may vary depending on national legislation and social security systems, common RTW coordination practices seems to transcend national boundaries [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe training duration recommended for RTW-C typically ranges from two to four days [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In our study, RTW-C training lasted only two days, focusing on PRATICA\u003csup\u003edr\u003c/sup\u003e tool usage, and practical guideline content for stakeholders. Given the diverse professional backgrounds of RTW-C personnel, future implementations of PRATICA\u003csup\u003edr\u003c/sup\u003e could benefit from supervision or co-development groups to enhance competencies and ensure comprehensive understanding of key issues [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Future research could also delve into identifying essential competencies for effective RTW coordination [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Finally, our study employed a quasi-experimental design with matched participants. Although this method exhibits robustness, particularly when multiple variables are utilized in the pairing, it is strongly recommended for future studies to conduct a randomized controlled trial (RCT).\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eCommon mental disorders (CMDs) have a significant impact on employees on sick leave, with relapse being common recurrences, carrying substantial public health and economic implications. The web platform PRATICA\u003csup\u003edr\u003c/sup\u003e utilized by a Return-to-Work Coordinator (RTW-C) outperformed the standard RTW-C intervention in two large organizations (public and private sectors). The experimental group exhibited positive and significant work outcomes, including an 85-day reduction in sick leave, irrespective of intervention onset, and an 81-day reduction when the intervention began after 2 months of sick leave. Furthermore, no relapses were observed in the experimental group, contrasting with a 13.2% relapse rate in the usual intervention group. These findings are supported by a reduction in clinical symptoms pre- and post-intervention in the experimental group. They underscore the significance of equipping an RTW-C with the addition of a platform that brings together key RTW stakeholders and utilizes validated tools and practical guides. Beyond study limitations, a randomized-controlled trial is warranted, alongside exhaustive assessments of RTW-C competencies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003eThe study follows the recommendations for research on human subjects as declared in the Helsinki Declaration. Ethical approval for this study was obtained from the research ethics board of the CIUSSS de l'Est-de-l'\u0026Icirc;le-de-Montr\u0026eacute;al (#MP-12-2018-1155 and #2018\u0026thinsp;\u0026minus;\u0026thinsp;1052). All participants provided informed consent prior to participating in the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests:\u003c/strong\u003e \u003cp\u003eThe authors have no conflict of interest to disclose.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study received funding support from the Research Chair in Mental Health and Work, funded by the Foundation of the Institut en sant\u0026eacute; mentale de Montr\u0026eacute;al and the CIUSSS-de-l'Est-de-l'\u0026Icirc;le-de-Montr\u0026eacute;al.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMC and MMC designed the study with the help of TL, SG, and AP. MC had the main responsibility for the quasi-experimental study from which the employees were recruited. CEG performed the statistical analysis and prepared tables and figures. MC led the writing, with significant input from MMC, TL, SG, AP, and CEG. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eThe authors gratefully acknowledge the individuals who participated in the study, as well as return-to-work coordinators.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e \u003cp\u003eThe datasets generated and analysed during the current study are not publicly available. Data are available upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGili M, Vicens C, Roca M, Andersen P, McMillan D. Interventions for preventing relapse or recurrence of depression in primary health care settings: A systematic review. Prev Med. 2015;76. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ypmed.2014.07.035\u003c/span\u003e\u003cspan address=\"10.1016/j.ypmed.2014.07.035\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Suppl:S16-21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJoyce S, Modini M, Christensen H, Mykletun A, Bryant R, Mitchell PB, et al. Workplace interventions for common mental disorders: a systematic meta-review. Psychol Med. 2016;46:683\u0026ndash;97. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/S0033291715002408\u003c/span\u003e\u003cspan address=\"10.1017/S0033291715002408\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAx\u0026eacute;n I, Br\u0026auml;mberg E, Vaez M, Lundin A, Bergstr\u0026ouml;m G. Interventions for common mental disorders in the occupational health service: a systematic review with a narrative synthesis. Int Arch Occup Environ Health 2020;93. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00420-020-01535-4\u003c/span\u003e\u003cspan address=\"10.1007/s00420-020-01535-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNigatu YT, Liu Y, Uppal M, McKinney S, Rao S, Gillis K, et al. Interventions for enhancing return to work in individuals with a common mental illness: systematic review and meta-analysis of randomized controlled trials. Psychol Med. 2016;46:3263\u0026ndash;74. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/S0033291716002269\u003c/span\u003e\u003cspan address=\"10.1017/S0033291716002269\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStratton E, Lampit A, Choi I, Calvo RA, Harvey SB, Glozier N. Effectiveness of eHealth interventions for reducing mental health conditions in employees: A systematic review and meta-analysis. PLoS ONE. 2017;12:e0189904. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0189904\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0189904\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNielsen K, Yarker J, Munir F, B\u0026uuml;ltmann U. IGLOO: An integrated framework for sustainable return to work in workers with common mental disorders. Work Stress. 2018;32:400\u0026ndash;17. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/02678373.2018.1438536\u003c/span\u003e\u003cspan address=\"10.1080/02678373.2018.1438536\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDewa CS, Loong D, Trojanowski L, Bonato S. The effectiveness of augmented versus standard individual placement and support programs in terms of employment: a systematic literature review. J Ment Health. 2018;27:174\u0026ndash;83. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/09638237.2017.1322180\u003c/span\u003e\u003cspan address=\"10.1080/09638237.2017.1322180\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDoran CM, Kinchin I. A review of the economic impact of mental illness. Aust Health Rev. 2019;43:43\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1071/AH16115\u003c/span\u003e\u003cspan address=\"10.1071/AH16115\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDewa CS, Trojanowski L, Joosen MCW, Bonato S. Employer Best Practice Guidelines for the Return to Work of Workers on Mental Disorder-Related Disability Leave: A Systematic Review. Can J Psychiatry. 2016;61:176\u0026ndash;85. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0706743716632515\u003c/span\u003e\u003cspan address=\"10.1177/0706743716632515\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLebeau M. Valeurs estim\u0026eacute;es par le Groupe de Connaissance et Surveillance Statistiques (GCSS) de l\u0026rsquo;IRSST \u0026agrave; partir de donn\u0026eacute;es provenant de la CSST (2005\u0026ndash;2007) 2015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVolker D, Vlasveld MC, Anema JR, Beekman AT, Roijen LH, Brouwers EP, et al. Blended E-health module on return to work embedded in collaborative occupational health care for common mental disorders: design of a cluster randomized controlled trial. Neuropsychiatr Dis Treat. 2013;9:529\u0026ndash;37. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2147/NDT.S43969\u003c/span\u003e\u003cspan address=\"10.2147/NDT.S43969\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVenning A, Oswald TK, Stevenson J, Tepper N, Azadi L, Lawn S, et al. Determining what constitutes an effective psychosocial \u0026lsquo;return to work\u0026rsquo; intervention: a systematic review and narrative synthesis. BMC Public Health. 2021;21:2164. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12889-021-11898-z\u003c/span\u003e\u003cspan address=\"10.1186/s12889-021-11898-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCorbi\u0026egrave;re M, Mazaniello-Ch\u0026eacute;zol M, Lecomte T, Guay S, Panaccio A. Developing a collaborative and sustainable return to work program for employees with common mental disorders: a participatory research with public and private organizations. Disabil Rehabil. 2022;44:5199\u0026ndash;211. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/09638288.2021.1931481\u003c/span\u003e\u003cspan address=\"10.1080/09638288.2021.1931481\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCorbi\u0026egrave;re M, Mazaniello-Ch\u0026eacute;zol M, Bastien M-F, Wathieu E, Bouchard R, Panaccio A, et al. Stakeholders\u0026rsquo; Role and Actions in the Return-to-Work Process of Workers on Sick-Leave Due to Common Mental Disorders: A Scoping Review. J Occup Rehabil. 2020;30:381\u0026ndash;419. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10926-019-09861-2\u003c/span\u003e\u003cspan address=\"10.1007/s10926-019-09861-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFranche R-L, Baril R, Shaw W, Nicholas M, Loisel P. Workplace-Based Return-to-Work Interventions: Optimizing the Role of Stakeholders in Implementation and Research. J Occup Rehabil. 2005;15:525\u0026ndash;42. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10926-005-8032-1\u003c/span\u003e\u003cspan address=\"10.1007/s10926-005-8032-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTikka C, Verbeek J, Hoving JL, Kunz R. Evidence-informed decision about (de-)implementing return-to-work coordination to reduce sick leave: a case study. Health Res Policy Syst. 2022;20:19. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12961-022-00823-4\u003c/span\u003e\u003cspan address=\"10.1186/s12961-022-00823-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSt\u0026aring;hl C. Implementing interorganizational cooperation in labour market reintegration: a case study. J Occup Rehabil. 2012;22:209\u0026ndash;19. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10926-011-9337-x\u003c/span\u003e\u003cspan address=\"10.1007/s10926-011-9337-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAndersen MF, Nielsen KM, Brinkmann S. Meta-synthesis of qualitative research on return to work among employees with common mental disorders. Scand J Work Environ Health. 2012;38:93\u0026ndash;104. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5271/sjweh.3257\u003c/span\u003e\u003cspan address=\"10.5271/sjweh.3257\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSkarpaas LS, Haveraaen LA, Sm\u0026aring;stuen MC, Shaw WS, Aas RW. Horizontal return to work coordination was more common in RTW programs than the recommended vertical coordination. The Rapid-RTW cohort study. BMC Health Serv Res 2019;19. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12913-019-4607-y\u003c/span\u003e\u003cspan address=\"10.1186/s12913-019-4607-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSkarpaas LS, Haveraaen LA, Sm\u0026aring;stuen MC, Shaw WS, Aas RW. The association between having a coordinator and return to work: the rapid-return-to-work cohort study. BMJ Open. 2019;9:e024597. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/bmjopen-2018-024597\u003c/span\u003e\u003cspan address=\"10.1136/bmjopen-2018-024597\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSv\u0026auml;rd V, Berglund E, Bj\u0026ouml;rk Br\u0026auml;mberg E, Gustafsson N, Engblom M, Friberg E. Coordinators in the return-to-work process: Mapping their work models. PLoS ONE. 2023;18:e0290021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0290021\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0290021\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHolmlund L, Hellman T, Engblom M, Kwak L, Sandman L, T\u0026ouml;rnkvist L, et al. Coordination of return-to-work for employees on sick leave due to common mental disorders: facilitators and barriers. Disabil Rehabil. 2022;44:3113\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/09638288.2020.1855263\u003c/span\u003e\u003cspan address=\"10.1080/09638288.2020.1855263\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVogel N, Schandelmaier S, Zumbrunn T, Ebrahim S, de Boer WE, Busse JW et al. Return-to-work coordination programmes for improving return to work in workers on sick leave. Cochrane Database Syst Reviews 2017;2017. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/14651858.CD011618.pub2\u003c/span\u003e\u003cspan address=\"10.1002/14651858.CD011618.pub2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKausto J, Oksanen T, Koskinen A, Pentti J, Mattila-Holappa P, Kaila-Kangas L, et al. Return to Work\u0026rsquo; Coordinator Model and Work Participation of Employees: A Natural Intervention Study in Finland. J Occup Rehabil. 2021;31:831\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10926-021-09970-x\u003c/span\u003e\u003cspan address=\"10.1007/s10926-021-09970-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEskilsson T, Norlund S, Lehti A, Wiklund M. Enhanced Capacity to Act: Managers\u0026rsquo; Perspectives When Participating in a Dialogue-Based Workplace Intervention for Employee Return to Work. J Occup Rehabil. 2021;31:263\u0026ndash;74. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10926-020-09914-x\u003c/span\u003e\u003cspan address=\"10.1007/s10926-020-09914-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVolker D, Zijlstra-Vlasveld MC, van der Brouwers EPM. Process Evaluation of a Blended Web-Based Intervention on Return to Work for Sick-Listed Employees with Common Mental Health Problems in the Occupational Health Setting. J Occup Rehabil. 2017;27:186\u0026ndash;94. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10926-016-9643-4\u003c/span\u003e\u003cspan address=\"10.1007/s10926-016-9643-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStrudwick G, Impey D, Torous J, Krausz RM, Wiljer D, Advancing. E-Mental Health in Canada: Report From a Multistakeholder Meeting. JMIR Ment Health. 2020;7:e19360. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2196/19360\u003c/span\u003e\u003cspan address=\"10.2196/19360\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEngdahl P, Svedberg P, Lex\u0026eacute;n A, Bejerholm U. Role of a Digital Return-To-Work Solution for Individuals With Common Mental Disorders: Qualitative Study of the Perspectives of Three Stakeholder Groups. JMIR Form Res. 2020;4:e15625. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2196/15625\u003c/span\u003e\u003cspan address=\"10.2196/15625\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhillips EA, Gordeev VS, Schrey\u0026ouml;gg J. Effectiveness of occupational e-mental health interventions: a systematic review and meta-analysis of randomized controlled trials. Scand J Work Environ Health. 2019;45:560\u0026ndash;76. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5271/sjweh.3839\u003c/span\u003e\u003cspan address=\"10.5271/sjweh.3839\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLecomte T, Potvin S, Corbi\u0026egrave;re M, Guay S, Samson C, Cloutier B, et al. Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses. JMIR Mhealth Uhealth. 2020;8:e17458. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2196/17458\u003c/span\u003e\u003cspan address=\"10.2196/17458\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKausto J, Pentti J, Oksanen T, Virta LJ, Virtanen M, Kivim\u0026auml;ki M, et al. Length of sickness absence and sustained return-to-work in mental disorders and musculoskeletal diseases: a cohort study of public sector employees. Scand J Work Environ Health. 2017;43:358\u0026ndash;66. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5271/sjweh.3643\u003c/span\u003e\u003cspan address=\"10.5271/sjweh.3643\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1046/j.1525-1497.2001.016009606.x\u003c/span\u003e\u003cspan address=\"10.1046/j.1525-1497.2001.016009606.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpitzer RL, Kroenke K, Williams JBW, L\u0026ouml;we B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/archinte.166.10.1092\u003c/span\u003e\u003cspan address=\"10.1001/archinte.166.10.1092\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFurukawa TA. Assessment of mood: guides for clinicians. J Psychosom Res. 2010;68:581\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jpsychores.2009.05.003\u003c/span\u003e\u003cspan address=\"10.1016/j.jpsychores.2009.05.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNieuwenhuijsen K, Verbeek JH, Neumeyer-Gromen A, Verhoeven AC, B\u0026uuml;ltmann U, Faber B. Interventions to improve return to work in depressed people. Cochrane Database Syst Rev. 2020;10:CD006237. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/14651858.CD006237.pub4\u003c/span\u003e\u003cspan address=\"10.1002/14651858.CD006237.pub4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRodriguez-Seijas C, Li JJ, Balling C, Brandes C, Bernat E, Boness CL, et al. Diversity and the Hierarchical Taxonomy of Psychopathology (HiTOP). Nat Reviews Psychol. 2023;2:483\u0026ndash;95. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/s44159-023-00200-0\u003c/span\u003e\u003cspan address=\"10.1038/s44159-023-00200-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eR Core Team. A Language and Environment for Statistical Computing_. R Foundation for Statistical Computing; 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTherneau T. _A Package for Survival Analysis in R_. R package version 3.5-7, 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCox DR. Regression Models and Life-Tables. Journal of the Royal Statistical Society: Series B (Methodological). 1972;34:187\u0026ndash;202. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.2517-6161.1972.tb00899.x\u003c/span\u003e\u003cspan address=\"10.1111/j.2517-6161.1972.tb00899.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVolker D, Zijlstra-Vlasveld MC, Anema JR, Beekman AT, Brouwers EP, Emons WH, et al. Effectiveness of a blended web-based intervention on return to work for sick-listed employees with common mental disorders: results of a cluster randomized controlled trial. J Med Internet Res. 2015;17:e116. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2196/jmir.4097\u003c/span\u003e\u003cspan address=\"10.2196/jmir.4097\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDewa CS, Hoch JS, Loong D, Trojanowski L, Bonato S. Evidence for the Cost-Effectiveness of Return-to-Work Interventions for Mental Illness Related Sickness Absences: A Systematic Literature Review. J Occup Rehabil. 2021;31:26\u0026ndash;40. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10926-020-09904-z\u003c/span\u003e\u003cspan address=\"10.1007/s10926-020-09904-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDol M, Varatharajan S, Neiterman E, McKnight E, Crouch M, McDonald E, et al. Systematic Review of the Impact on Return to Work of Return-to-Work Coordinators. J Occup Rehabil. 2021;31:675\u0026ndash;98. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10926-021-09975-6\u003c/span\u003e\u003cspan address=\"10.1007/s10926-021-09975-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCorbi\u0026egrave;re M, Villotti P, Berbiche D, Lecomte T. Predictors of job tenure for people with a severe mental illness, enrolled in supported employment programs. Psychiatr Rehabil J. 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/prj0000589\u003c/span\u003e\u003cspan address=\"10.1037/prj0000589\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMacEachen E, McDonald E, Neiterman E, McKnight E, Malachowski C, Crouch M, et al. Return to Work for Mental Ill-Health: A Scoping Review Exploring the Impact and Role of Return-to-Work Coordinators. J Occup Rehabil. 2020;30:455\u0026ndash;65. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10926-020-09873-3\u003c/span\u003e\u003cspan address=\"10.1007/s10926-020-09873-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"web application, stakeholder, return-to-work coordinator, clinical symptoms, cost-savings","lastPublishedDoi":"10.21203/rs.3.rs-4137951/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4137951/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCommon mental disorders (CMDs) are highly prevalent in workplace settings, and have become a significant public health challenge. This study aims to assess the effectiveness of PRATICA\u003csup\u003edr\u003c/sup\u003e, a web application facilitated by a Return-to-Work Coordinator (RTW-C), with a focus on reducing sick leave duration and preventing relapse in individuals with CMDs.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003ePRATICA\u003csup\u003edr\u003c/sup\u003e, designed to enhance collaboration among Return-to-Work (RTW) stakeholders and provide systematic support throughout the RTW process, was evaluated in a quasi-experimental study. Survival analyses were used to compare sick leave durations and relapses between the experimental group (PRATICA\u003csup\u003edr\u003c/sup\u003e with RTW-C), and control groups (RTW-C only). Both conditions had equal distribution of 50% from a large public health organization (n\u0026thinsp;=\u0026thinsp;35) and 50% from a large private financial organization (n\u0026thinsp;=\u0026thinsp;35). Mixed linear models were used to observe changes in clinical symptoms over time, especially for the experimental group.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe experimental group demonstrated significantly shorter sick leave durations and fewer relapses compared to the control group. Notably, the average absence duration was close to 3 months shorter in the experimental group. This difference was found when the RTW-C intervention (rehabilitation care) began 2 months after the onset of sick leave. Relapses occurred only in the control group (13.2%). The absence of relapses in the experimental group is noteworthy, along with the significant decrease in depressive and anxious symptoms over time.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe findings suggest that incorporating PRATICA\u003csup\u003edr\u003c/sup\u003e into RTW-C intervention can lead to substantial cost savings by facilitating coordination among stakeholders and guiding the RTW process with validated tools. Initiation of RTW-C intervention alongside PRATICA\u003csup\u003edr\u003c/sup\u003e within the first month of absence is recommended for optimal health and work outcomes.\u003c/p\u003e","manuscriptTitle":"Web-Enhanced Return-to-Work Coordination for employees with common mental disorders: Reduction of sick leave duration and relapse","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-25 18:09:37","doi":"10.21203/rs.3.rs-4137951/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-05T05:35:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-04T09:50:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-02T14:39:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"139564715036375780843690296919506084905","date":"2024-10-02T09:22:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"155016918074360615419265251890329977401","date":"2024-09-29T07:48:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"328141435878181431207485293242122734006","date":"2024-09-20T07:19:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-04-16T11:49:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-04-16T05:54:27+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-21T08:03:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2024-03-20T14:41:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bd253daa-82a7-413a-9d28-5c74025ddf29","owner":[],"postedDate":"March 25th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-02-24T16:04:37+00:00","versionOfRecord":{"articleIdentity":"rs-4137951","link":"https://doi.org/10.1186/s12889-025-21716-5","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2025-02-18 15:58:04","publishedOnDateReadable":"February 18th, 2025"},"versionCreatedAt":"2024-03-25 18:09:37","video":"","vorDoi":"10.1186/s12889-025-21716-5","vorDoiUrl":"https://doi.org/10.1186/s12889-025-21716-5","workflowStages":[]},"version":"v1","identity":"rs-4137951","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4137951","identity":"rs-4137951","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}