5 - (OP12) Metacognitive Therapy with Work-focus for Patients on Sick Leave with Depression and Anxiety: A Randomised Controlled Trial

Background:
Employment is a key determinant of health, yet mental health treatments show limited effects on return to work (RTW) among patients with depression and anxiety. There is a need for interventions that simultaneously target symptoms and occupational functioning. This study investigated the effectiveness of metacognitive therapy combined with a structured work-focus (MCT+WF) in improving RTW and reducing symptoms in patients on sick leave.

Methods:
This single-centre, open-label randomised controlled trial was conducted at an outpatient mental health clinic in Norway. Adults on sick leave due to depression, anxiety, or comorbid depression and anxiety were randomly assigned to immediate MCT+WF or delayed treatment following a waitlist period. Randomisation was computer-generated and stratified by gender and percentage of sick leave. Primary outcomes were RTW at 12 weeks, measured using national registry data and self-report, and symptoms of depression (BDI-II) and anxiety (BAI). Analyses followed the intention-to-treat principle. Outcome assessors were blinded.

Results:
A total of 236 patients were randomised (immediate MCT+WF: n=121; waitlist: n=115). At 12 weeks, registry-based RTW was significantly higher in the immediate MCT+WF group compared with waitlist (39% vs 20%; OR=2.39, 95% CI 1.32–4.32; p=0.004). Self-reported RTW showed a similar pattern (42% vs 18%; OR=3.44, 95% CI 1.87–6.35; p< 0.0001). Multilevel analyses demonstrated significantly greater reductions in anxiety and depression symptoms in the immediate treatment group compared with waitlist (time × group interaction p< 0.0001 for both outcomes). No serious adverse events were reported.

Conclusions:
Metacognitive therapy combined with a structured work-focus significantly improved return to work and reduced symptoms of depression and anxiety compared with waiting. The findings suggest that integrating work-focused components within evidence-based psychological treatments may enhance functional recovery and occupational participation. MCT+WF represents a promising and scalable approach for improving both mental health and work outcomes among patients on sick leave.