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1 Introduction
Sickness and disability benefits expenditures are substantial in many
countries. In 2007, the average OECD country spent 1.9 percent of GDP on
sickness and disability benefits, or about 10 percent of public social
spending (OECD, 2010). This was almost three times as much as the
average cost for unemployment. Two of the most common causes of work
absence due to illness, what we denote as sick leave, are mental and
chronic pain diseases. About 20 percent of the population in an average
OECD country suffers from mental illness at any point in time and up to 50
percent experiences mental illness at some point during their life (OECD,
2012). Similarly, about 19 percent of adult Europeans suffer from chronic
pain of moderate to severe intensity (Breivik et al, 2006). These diseases
severely affect the quality of social and working lives of individuals. The
costs to society are also large, not only covering the direct costs to the
health care system but also indirect costs such as decreased productivity
and public benefit payments. Tackling mental health problems and chronic
pain is a key challenge for modern society.
An important question is what types of treatment can be effective not only
in improving health but also in facilitating employment for individuals with
mental illness or chronic pain. For labor market outcomes in particular, the
evidence remains scarce. There are studies suggesting that psychological
treatments, in particular cognitive behavioral therapy (CBT), lead to
symptom improvements for anxiety and depression (see, e.g., the review
by The Swedish Council on Health Technology Assessment (SBU, 2004)). In
a survey of studies on interventions to improve occupational health in
depressed people, however, Nieuwenhuijsen et al. (2008) conclude that
that there is no evidence that medication alone or enhanced primary care
reduces work disability in depressed workers, and that there is no evidence
for or against the effectiveness of psychological interventions in terms of
work disability.
The Swedish Council on Health Technology Assessment (SBU, 2006 and
2010) and Scascighini et al (2008) survey the literature on methods for
treatment of chronic pain. Existing evidence suggests that multidisciplinary
treatment, including a combination of psychological interventions and
physical training, facilitates return to work, decreases sick leave and
improves self-assessed health. However, the most recent survey (SBU,
2010) does not provide support for multidisciplinary treatment decreasing
pain intensity, activity capacity or other symptoms compared to less
intensive measures or no measures at all. SBU (2006 and 2010) also
conclude that behavioral medical treatment leads to better activity capacity
than physical measures without behavioral components, and that
acupuncture leads to no difference in pain intensity compared to control
methods with other types of stimulation.