Open Access Study protocol

Return to work of workers without a permanent employment contract, sick-listed due to a common mental disorder: design of a randomised controlled trial

Lieke Lammerts12, Sylvia J Vermeulen12, Frederieke G Schaafsma12, Willem van Mechelen12 and Johannes R Anema12*

Author Affiliations

1 Department of Public and Occupational Health, EMGO + Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, Amsterdam 1007 MB, The Netherlands

2 Research Centre for Insurance Medicine AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands

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BMC Public Health 2014, 14:594  doi:10.1186/1471-2458-14-594

Published: 12 June 2014



Workers without a permanent employment contract represent a vulnerable group within the working population. Mental disorders are a major cause of sickness absence within this group. Common mental disorders are stress-related, depressive and anxiety disorders. To date, little attention has been paid to effective return to work interventions for this type of sick-listed workers. Therefore, a participatory supportive return to work program has been developed. It combines elements of a participatory return to work program, integrated care and direct placement in a competitive job.

The objective of this paper is to describe the design of a randomised controlled trial to evaluate the cost-effectiveness of this program compared to care as usual.


The cost-effectiveness of the participatory supportive return to work program will be examined in a randomised controlled trial with a follow-up of twelve months.

The program strongly involves the sick-listed worker in the identification of obstacles for return to work and possible solutions, resulting in a consensus based action plan. This plan will be used as a starting point for the search of suitable competitive employment with support of a rehabilitation agency. During this process the insurance physician of the sick-listed worker contacts other caregivers to promote integrated care.

Workers eligible to participate in this study have no permanent employment contract, have applied for a sickness benefit at the Dutch Social Security Agency and are sick-listed between two and fourteen weeks due to mental health problems.

The primary outcome measure is the duration until first sustainable return to work in a competitive job. Outcomes are measured at baseline and after three, six, nine and twelve months.


If the participatory supportive return to work program proves to be cost-effective, the social security system, the sick-listed worker and society as a whole will benefit. A cost-effective return to work program will lead to a reduction of costs related to sickness absence. For the sick-listed worker a cost-effective program results in earlier sustainable return to work, which can be associated with both social and health benefits.

Trial registration

The trial registration number and date is NTR3563, August 7, 2012.

Return to work; Intervention; Sickness absence; Common mental disorders; Unemployed workers; Temporary agency workers; Fixed-term contract workers; Vulnerable workers; Occupational health care; Social security; Randomised controlled trial