Prompt mental health care (PMHC) is a Norwegian initiative, inspired by the English ‘Improving Access to Psychological Therapy’ (IAPT), aimed to provide low-threshold access to primary care treatment for persons with symptoms of anxiety and depression. The objectives of the present study are to describe the PMHC service, to examine changes in symptoms of anxiety and depression following treatment and to identify predictors of change, using data from the 12 first pilot sites. A prospective cohort design was used. All participants were asked to complete questionnaires at baseline, before each treatment session and at the end of treatment. Effect sizes (ES) for pre-post changes and recovery rates were calculated based on the Patient Health Questionnaire and the Generalized Anxiety Disorder scale. Multiple imputation (MI) was used in order to handle missing data. We examined predictors through latent difference score models and reported the contribution of each predictor level in terms of ES. In total, N = 2512 clients received treatment at PMHC between October 2014 and December 2016, whereof 61% consented to participate. The changes from pre- to post-treatment were large for symptoms of both depression (ES = 1.1) and anxiety (ES = 1.0), with an MI-based reliable recovery rate of 58%. The reliable recovery rate comparable to IAPT based on last-observation-carried-forward was 48%. The strongest predictors for less improvement were having immigrant background (ES change depression − 0.27, ES change anxiety − 0.26), being out of work at baseline (ES change depression − 0.18, ES change anxiety − 0.35), taking antidepressants (ES change anxiety − 0.36) and reporting bullying as cause of problems (ES change depression − 0.29). Taking sleep medication did on the other hand predict more improvement (ES change depression 0.23, ES change anxiety 0.45). Results in terms of clinical outcomes were promising, compared to both the IAPT pilots and other benchmark samples. Though all groups of clients showed substantial improvements, having immigrant background, being out of work, taking antidepressant medication and reporting bullying as cause stood out as predictors of poorer treatment response. Altogether, PMHC was successfully implemented in Norway. Areas for improvement of the service are discussed.

Aims : The contribution of general psychological aspects, such as emotions, has received little focus in research on sickness absence. We wanted to study the relationship between shame and sickness absence, which factors that explained differences in levels of shame, and if shame predicted subsequent sickness absence. Methods : We employed a Swedish population-based cohort of current sickness absentees (19–64 years old), responding to a mailed questionnaire in 2008. Data was linked to national registries on sickness absence. Results : The young, those born outside the Nordic countries, those on lower incomes and those with higher level of education reported being more ashamed of their sickness absence. Those with more sickness absence in the past were also more likely to report higher levels of shame. Level of shame was not associated with gender or occupational class. Compared to those absent for a somatic cause, mental or co-morbid illness was associated with higher levels of shame. Those reporting high level of shame were more likely to have prolonged sickness absence the following year. Symptoms of depression at baseline only partly explained these associations. Conclusions : Our results suggest that shame might prolong sickness absence. Increased understanding of the impact of social and emotional aspects around sickness absence could be an important source for improved quality of rehabilitation.

Objective Although sickness absence often is a process over time, most studies have treated the phenomenon as a discrete event and focused more on its causes than its consequences. We aimed to examine whether various patterns of previous long-term sickness absence were associated with current low perceived social support at work. Method This is a historical cohort study based on data from a population-based survey among Swedish employees (n=2581). The survey data were linked to official registries yielding data on sickness absence 1–7 years prior to the survey. Results The main finding was that previous sickness absence was associated with current low perceived social support at work. The highest odds for low social support were found among those who had a stable high level of sickness absence. The two indicators of perceived social support employed were somewhat differently associated with previous sickness absence: Recency of absence showed to be of importance for general support at the workplace and the relationship with colleagues and superiors. Experiencing that one's immediate superior rarely or never regards one's view was, on the other hand, mainly related to having had a high level of sickness absence, irrespective of recency. Conclusions Our results indicate that recency and extent of previous sickness absence are related to perceived social support at work. Future research on the relationship between social support and sickness absence should use repeated measurements and acknowledge the possible bidirectional relationship.

Although life course influences have long been recognised in affective disorder, little is known about the influence of early life factors on late life anxiety and depression. The aim was to investigate the extent to which birth measures, maternal health and family circumstances were associated with symptoms of anxiety and depression in late life. A retrospective cohort study was constructed from a cross-sectional survey sample of community residents aged 72–74 years, 406 of whom had traceable birth records. Cases and controls for late life anxiety and depression were defined applying standard cut-offs to the Hospital Anxiety and Depression Scale. A range of measures and circumstances were extracted from birth records blind to survey data and compared in age- and gender-adjusted models. There were no differences in any anthropometric measure in either case control comparison. Case-level anxiety and depression were both associated with significantly lower maternal age. Late-life anxiety was additionally associated with smaller maternal pelvic size and the mother’s condition being rated as poor at birth/discharge. Late-life depression was associated with a lower status paternal occupation. There was no evidence for a substantial influence of early life size on late life affective disorder. However, there was some evidence in secondary analyses for an enduring influence of the family’s socioeconomic environment and maternal health.

Background: Prompt Mental Health Care (PMHC) service is a Norwegian initiative, adapted from the English ‘Improved Access to Psychological Therapy’ (IAPT), aimed at improving access to primary care treatment for anxiety and depression. Thus far, both PMHC and IAPT have been evaluated by cohort studies only. Albeit yielding promising results, the extent to which these are attributable to the treatment thus remains unsettled. This study investigates the effectiveness of PMHC compared to treatment as usual (TAU) at six months follow-up. Methods: Randomized controlled trial with parallel assignment in two PMHC sites from November 2015 to March 2018. Participants were 681 adults (aged ≥18 years) considered for admission to PMHC due to anxiety and/or mild to moderate depression. These were randomly assigned on a 70:30 ratio. Main outcomes were recovery rates and changes in symptoms of depression and anxiety between baseline and follow-up. Primary outcome data were available for 73%/67% in the PMHC/TAU group. Sensitivity analyses based on observed patterns of missingness were conducted. Results: A reliable recovery rate of 58.5% was observed in the PMHC group and 31.9% in the TAU group, yielding a between-group effect size (ES) of 0.61 [95% CI 0.37-0.85, p<.001]. The differences in degree of improvement between PMHC and TAU yielded an ES of -0.88 [95% CI -1.23-0.43, p < 0.001] for symptoms of depression and -0.60 [95% CI -0.90-0.30, p < 0.001] for symptoms of anxiety in favour of PMHC. All sensitivity analyses pointed in the same direction with small variations in point estimates. Findings were slightly more robust for depressive than anxiety symptoms. Conclusions: The PMHC treatment was substantially more effective than TAU in alleviating symptoms of anxiety and depression. This adaptation of IAPT is considered a viable supplement to existing health services to increase access of effective treatment for adults who suffer from anxiety and mild to moderate depression. Key messages: This study is the first to evaluate the effectiveness of an IAPT-like treatment model in terms of a randomized controlled trial. Prompt Mental Health Care was substantially more effective than TAU in alleviating symptoms of depression and anxiety at 6-months follow-up.

Background: Early identification of persons at risk for sickness absence offers an opportunity to put in place preventive measures in the future. The Work Stress Questionnaire (WSQ) is specifically designed to identify people at risk for sickness absence due to work-related stress. In this study we examine prospective associations between work-related stress as measured by the WSQ and registered sickness absence up till 10 years later among employed and self-employed women in the general population in Gothenburg. Methods: This is a survey-linkage study based on the 2004-05 wave of the Swedish “Population Study of Women in Gothenburg (PSWG)” and 10-year follow-up in the MiDAS sickness absence register. Participants registered as employed or self-employed were included (n = 396). Outcomes were number of sickness absence episodes during follow-up and sickness absence during each two-year time band of follow-up. Results: High perceived stress due to poor organizational climate, compared to low stress, gave an adjusted Incidence Risk Rate (IRR) of 1.99 [95% CI 1.19-3.34] for sickness absence episodes. Combining high perceived stress due to poor organizational climate with high perceived stress due to work commitment gave an IRR of 2.32 [95% CI 1.26-4.26]. Examining separate time periods, similar associations were found during years 5-6 and 7-8. Perceived low influence at work also gave increased odds for sickness absence, at both in the shorter term (1st-2nd year) and longer term (7th-8th year). Conclusions: The findings align with previous studies that WSQ may successfully identify women with elevated risk for future sickness absence, and adds that this is even true in a general population context and using a very long follow-up period. Nevertheless, the findings should preferably be confirmed using a larger sample to improve precision of the observed associations. Key messages: The present study contribute with knowledge about screening instruments that may identify women in the general working population with elevated risk for sickness absence. The findings suggest that high perceived stress due to organizational climate, alone and in combination with high work commitment, as well as low influence at work, increase risk of sickness absence.