Graded return to work (GRTW) is a useful strategy to bring chronically ill persons gradually back to coping with a full work load after a longer period of sick leave. Several studies showed for patients with somatic diseases that GRTW increases the probability of RTW. Patients with mental health disorders showed less encouraging results. This study aims to determine the effect of GRTW on longer-term occupational participation in persons with common mental disorders.

The data was extracted from a larger cohort study into the effectiveness after multimodal Rehabilitation on behalf of the German Pension Insurance (GPI). Patients with chronic mental disorders in a clinical rehabilitation setting were included. Questionnaires at the start of a multmodal rehabilitation and 15 months later were provided. Balanced groups (GRTW, noGRTW) were formed by propensity score matching based on 27 covariates. The Primary outcomes were the RTW at follow-up and the number of days on sick leave during follow-up.

From 1062 data sets (GRTW: 508, noGRTW: 554), 381 pairs were matched (age: 47.8 yrs; 78% female; 65% affective disorders, 28% neurotic or somatic disorders). At follow-up, 88% of the GRTW group had returned to work compared to only 73% of the controls (RR=1.22, 1.13 to 1.31). The mean sick leave duration during the follow-up period was 7.0 weeks in the GRTW group compared to 13.4 weeks in the control group (P<0.001). Additional explorative analyses showed that these effects were only observed in patients with an unsure or negative subjective RTW prognosis.

GRTW in addition to a multimodal rehabilitation is effective in enhancing successful work participation in people with chronic mental disorders. GRTW after multimodal rehabilitation is particularly suitable for patients with a critical subjecitve RTW prognosis.