Health‐improving interventions for obtaining employment in unemployed job seekers New

Abstract

Abstract Background

Unemployment is associated with decreased health which may be a reason or a consequence of becoming unemployed. Decreased health can inhibit re‐employment.

Objectives

To assess the effectiveness of health‐improving interventions for obtaining employment in unemployed job seekers.

Search methods

We searched (3 May 2018, updated 13 August 2019) the Cochrane Central Register of Controlled Trials, MEDLINE, Scopus, PsycINFO, CINAHL, SocINDEX, OSH Update, ClinicalTrials.gov, the WHO trials portal, and also reference lists of included studies and selected reviews.

Selection criteria

We included randomised controlled trials (RCTs) of the effectiveness of health‐improving interventions for obtaining employment in unemployed job seekers. The primary outcome was re‐employment reported as the number or percentage of participants who obtained employment. Our secondary outcomes were health and work ability.

Data collection and analysis

Two authors independently screened studies, extracted outcome data, and assessed risk of bias. We pooled study results with random‐effect models and reported risk ratios (RRs) with 95% confidence intervals (CIs) and assessed the overall quality of the evidence for each comparison using the GRADE approach.

Main results

We included 15 randomised controlled trials (16 interventions) with a total of 6397 unemployed participants. Eight studies evaluated therapeutic interventions such as cognitive behavioural therapy, physical exercise, and health‐related advice and counselling and, in seven studies, interventions were combined using therapeutic methods and job‐search training.

Therapeutic interventions

Therapeutic interventions compared to no intervention may increase employment at an average of 11 months follow‐up but the evidence is very uncertain (RR = 1.41, 95% CI 1.07 to 1.87, n = 1142, 8 studies with 9 interventions, I² = 52%, very low‐quality evidence). There is probably no difference in the effects of therapeutic interventions compared to no intervention on mental health (SMD 0.12, 95% CI ‐0.06 to 0.29, n = 530, 2 studies, low‐quality evidence) and on general health (SMD 0.19, 95% CI ‐0.04 to 0.41, n = 318, 1 study, moderate‐quality evidence).

Combined interventions

Combined interventions probably increase employment slightly compared to no intervention at an average of 10 months follow‐up (RR 1.12, 95% CI 1.06 to 1.20, n = 4101, 6 studies, I² = 7%).

There were no studies that measured work‐ability, adverse events, or cost‐effectiveness.

Authors' conclusions

Interventions combining therapeutic methods and job‐search training probably have a small beneficial effect in increasing employment. Therapeutic interventions may have an effect on re‐employment, but we are very uncertain. Therapeutic interventions may not improve health in unemployed job seekers. Large high‐quality RCTs targeting short‐term or long‐term unemployed people are needed to increase the quality of the evidence. A cost‐effectiveness assessment is needed of the small beneficial effects.

Author(s)

Marja Hult, Kirsi Lappalainen, Terhi K Saaranen, Kimmo Räsänen, Christophe Vanroelen, Alex Burdorf

Abstract

Plain language summary

Health‐improving interventions helping unemployed job seekers to get a job

What is the aim of this review?

The aim of this Cochrane review was to find out if it is possible to help unemployed people to get a job by improving their health.

Decreased health and declined work ability may be reasons for becoming unemployed. Also, unemployment, and especially prolonged unemployment, may in turn cause poor health and well‐being. It is not known if unemployed people could be helped to get a job by interventions that improve health.

Key messages

Interventions that combine therapeutic methods and job‐search training probably slightly increase the number of unemployed people who get a job compared to those who have no intervention. To increase the certainty of the evidence, we still need more high‐quality studies, including studies where interventions are clearly targeted for short‐term or long‐term unemployed.

What was studied in the review?

We included 15 randomised controlled trials involving 6397 participants. Interventions included therapeutic methods such as cognitive behavioural therapy, physical exercise, and health‐related advice and counselling, or they were combined interventions that included therapeutics and job‐search training. We used the data from these studies about the number of unemployed participants who obtained a job. We also collected data about general and mental health. There were no studies that reported work ability outcomes.

Results showed that combined interventions (therapeutic interventions combined with job‐search training) probably slightly increase the number of unemployed people who get a job compared to those who do not follow an intervention.Therapeutic interventions may increase the number of unemployed people who get a job compared to those who do not follow an intervention but the evidence is very uncertain. Therapeutic interventions probably make no difference to mental and general health compared to no intervention.

How up to date is this review?

We searched for studies that had been published up to August 2019.

Author(s)

Marja Hult, Kirsi Lappalainen, Terhi K Saaranen, Kimmo Räsänen, Christophe Vanroelen, Alex Burdorf

Reviewer's Conclusions

Authors' conclusions

Implications for practice

Based on the results of 15 trials, therapeutic interventions compared to no intervention may increase employment, but the evidence is very uncertain. There may be no difference in the effects of therapeutic interventions compared to no intervention on mental health and on general health. Combined interventions that included therapeutic methods and job‐search training probably slightly increase employment compared to no intervention.

Implications for research

The most common follow‐up time was four months in studies included in this review. Therefore, we recommend that studies with longer follow‐up times should be carried out. Short follow‐up may not be sufficient for assessing how people manage to get and maintain sustainable employment. The included studies were all RCTs, but these were at high risk of bias in allocation concealment and blinding of participants and personnel. Some studies stated that blinding was not feasible; nevertheless, some studies were blinded. In this review, more than half of the included studies had fewer than 50 participants per condition. Therefore, we recommend that RCTs with larger sample sizes should be conducted. Future interventions should be targeted to either short‐term or long‐term unemployed, because these groups have very distinct employability perspectives and needs for support. In terms of health‐improving interventions, the short‐term unemployed may need a slight boost for self‐efficacy, whereas the long‐term unemployed may benefit from a more therapeutic approach and rehabilitation.

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