Discussion
depression, anxiety
REMISSION
This trial was conducted to test if INT would improve the RTW process of persons on sick leave with anxiety or depression. The long-term results of this trial do not generally support our hypotheses, as SAU and INT differed neither on vocational nor on self-assessed outcomes. Compared to MHC, though, INT showed some vocational benefits in terms of weeks in work and time to RTW.Establishing true integration of the intervention components in INT proved to be a difficult, time-consuming venture that was complicated by distrust and diverging goals and norms between the involved organizations [The disappearance of effect on proportion in work, specifically between 12- and 24-month follow-up, could be due to several factors. First, the interventions in INT spanned several months, and for many participants it lasted more than 6 months after randomization. Despite the fact that a substantial proportion of the participants had still not returned to work 12 months after randomization, practically nobody received any interventions beyond that point. This could explain why no effect was seen thereafter. If so, a long-term effect might be achievable if the intervention is continued for participants who have still not returned to work after 12 months. Second, the disappearance of effect on this outcome may be caused by spontaneous remission to a ceiling level in the SAU group between 12- and 24-month follow-up, while this ceiling was reached just before 12-month follow-up in the INT group as a result of the intervention. If that explains most of the difference in effect, this group (at baseline) should still be considered at high risk of long-term negative vocational outcomes that call for the development of effective interventions. Third, it may matter that some of the practitioners delivering the interventions were only trained for a rather short period of time and hence lacked experience, unlike in other studies of effective RTW interventions (see for example [