Claire Henderson1, Elaine Brohan, Sarah Clement, Paul Williams, Francesca Lassman, Oliver Schauman, Lisa Dockery, Simone Farrelly, Joanna Murray, Caroline Murphy, Mike Slade, Graham Thornicroft. 1. Claire Henderson, PhD, MRCPsych, Elaine Brohan, PhD, Sarah Clement, PhD, Cpsychol, Paul Williams, MSc, Francesca Lassman, MSc, Oliver Schauman, MSc, Lisa Dockery, MSc, Simone Farrelly, PhD, Joanna Murray, BA, Health Service and Population Research Department, Institute of Psychiatry, King's College London; Caroline Murphy, DipHE Nursing (Adult), MSc Clinical Trials, KCTU, Department of Biostatistics, Institute of Psychiatry, King's College London; Mike Slade, PhD, PsychD, Graham Thornicroft, PhD, FRCPsych, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK.
Abstract
BACKGROUND: Many mental health service users delay or avoid disclosing their condition to employers because of experience, or anticipation, of discrimination. However, non-disclosure precludes the ability to request 'reasonable adjustments'. There have been no intervention studies to support decision-making about disclosure to an employer. AIMS: To determine whether the decision aid has an effect that is sustained beyond its immediate impact; to determine whether a large-scale trial is feasible; and to optimise the designs of a larger trial and of the decision aid. METHOD: In this exploratory randomised controlled trial (RCT) in London, participants were randomly assigned to use of a decision aid plus usual care or usual care alone. Follow-up was at 3 months. Primary outcomes were: (a) stage of decision-making; (b) decisional conflict; and (c) employment-related outcomes (trial registration number: NCT01379014). RESULTS: We recruited 80 participants and interventions were completed for 36 out of 40 in the intervention group; in total 71 participants were followed up. Intention-to-treat analysis showed that reduction in decisional conflict was significantly greater in the intervention group than among controls (mean improvement -22.7 (s.d. = 15.2) v. -11.2 (s.d. = 18.1), P = 0.005). More of the intervention group than controls were in full-time employment at follow-up (P = 0.03). CONCLUSIONS: The observed reduction in decisional conflict regarding disclosure has a number of potential benefits which next need to be tested in a definitive trial.
BACKGROUND: Many mental health service users delay or avoid disclosing their condition to employers because of experience, or anticipation, of discrimination. However, non-disclosure precludes the ability to request 'reasonable adjustments'. There have been no intervention studies to support decision-making about disclosure to an employer. AIMS: To determine whether the decision aid has an effect that is sustained beyond its immediate impact; to determine whether a large-scale trial is feasible; and to optimise the designs of a larger trial and of the decision aid. METHOD: In this exploratory randomised controlled trial (RCT) in London, participants were randomly assigned to use of a decision aid plus usual care or usual care alone. Follow-up was at 3 months. Primary outcomes were: (a) stage of decision-making; (b) decisional conflict; and (c) employment-related outcomes (trial registration number: NCT01379014). RESULTS: We recruited 80 participants and interventions were completed for 36 out of 40 in the intervention group; in total 71 participants were followed up. Intention-to-treat analysis showed that reduction in decisional conflict was significantly greater in the intervention group than among controls (mean improvement -22.7 (s.d. = 15.2) v. -11.2 (s.d. = 18.1), P = 0.005). More of the intervention group than controls were in full-time employment at follow-up (P = 0.03). CONCLUSIONS: The observed reduction in decisional conflict regarding disclosure has a number of potential benefits which next need to be tested in a definitive trial.
Authors: A Isaksson; E Corker; J Cotney; S Hamilton; V Pinfold; D Rose; N Rüsch; C Henderson; G Thornicroft; S Evans-Lacko Journal: Epidemiol Psychiatr Sci Date: 2017-05-02 Impact factor: 6.892
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