This review concluded that there was weak evidence to support use of vocational interventions to improve work participation and limited evidence to reduce mental distress in unemployed individuals. Further research was needed. This was a generally well-conducted review and the authors' conclusions and recommendation for further research seem appropriate.

To assess the effectiveness of vocational interventions on work participation and mental distress for unemployed adults.

MEDLINE, EMBASE and PsycINFO were searched for articles published in English, German, Dutch and French between 1990 and August 2008. Search terms were reported. References of selected articles were searched manually.

Randomised controlled trials (RCTs), controlled clinical trials, pre-post studies with longitudinal follow-up and case series in unemployed adults aged between 18 and 65 years with mental distress complaints or distress were eligible for inclusion. Eligible studies were required to assess interventions aimed at return to work, resuming work, job application and/or improved functioning (excluding trials using drugs as the primary intervention) and to measure distress pre- and post-intervention.

Included studies were conducted in Australia, USA and Finland. Participants were unemployed for 4.11 weeks up to one year. Where reported, mean age ranged from 33 to 37 years. Some patients were categorised as low or high risk respondents (high risk was defined as higher depression score and financial strain and lower assertiveness score). All studies were of group interventions. Some studies used similar interventions, which included training courses or workshops to increase motivation and enhance job-search skills and self-efficacy for re-employment; some included subsidised employment. Study durations ranged from one week to six months. Controls were added to a training course waiting list, received booklets or literature packs on job-search methods or received no intervention, or were non-study participants. Primary outcomes were employment status and functioning (role and emotional). Secondary outcomes included psychological distress (mostly measured using the 12- or 20-item General Health Questionnaire). Post-intervention measurements ranged from three months to two years.

Two reviewers independently selected studies for inclusion. Disagreements were referred to a third reviewer.

Two reviewers independently assessed study quality according to the Downs and Black 27-item tool with criteria on external validity, internal validity (bias and confounding) and statistical power. The maximum score for RCTs was 28 and for non-randomised studies was 25. Studies were classed as excellent (scoring 26 to 28), good (20 to 25), fair (15 to 19) and poor (14 or less). Disagreements were resolved by consensus.

One reviewer extracted outcome data from individual studies and this was checked by a second reviewer. Discrepancies were resolved by consensus.

The data were presented as a narrative synthesis.

Five studies (n=4,026) were included in the review: two RCTs, one non-randomised controlled trial and two longitudinal studies with pre- and post-treatment measurements. RCT quality was fair (scored 18) and good (scored 20). Other studies were of poor or fair quality (scored 9, 13 and 19).

One RCT showed a statistically significant increase in re-employment (p<0.01) at two-year follow-up compared with controls. The two RCTs used similar interventions that were based on the principles of the JOBS II intervention. Both RCTs reported a statistically significant decrease in psychological distress in participants who received the intervention compared with controls (p<0.05). The other three studies showed no statistically significant differences in re-employment or psychological distress.

There was weak evidence to support use of vocational interventions to improve work participation and limited evidence to reduce mental distress in unemployed individuals. Further research was needed.

The review question was clear and supported by appropriate inclusion criteria. The literature search included several appropriate sources, but language restrictions and the apparent lack of a search for unpublished data may have caused potentially relevant papers to be missed. A formal assessment of study quality was undertaken with appropriate criteria; most studies were classed as fair quality. The authors undertook each stage of the review process in duplicate, which minimised potential for reviewer error and bias. A narrative synthesis seemed appropriate given that some studies provided limited data on study participants.

This was a generally well-conducted review. The authors' conclusions appear to reflect the limited evidence available and their recommendation for further research seems appropriate.

Practice: The authors did not state any implications for practice.

Research: The authors stated that further development and evaluation of return to work interventions (including behavioural components) were needed for unemployed adults.

Not stated.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.