Lee 20183535. Lee Y, Rosenblat JD, Lee J, Carmona NE, Subramaniapillai M, Shekotikhina M, et al. Efficacy of antidepressants on measures of workplace functioning in major depressive disorder: A systematic review. J Affect Disord 2018; 227: 406-415. doi: 10.1016/j.jad.2017.11.003. PMID: 29154157. https://doi.org/10.1016/j.jad.2017.11.00...
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Systematic review of clinical trials that evaluated the effects of antidepressants on functionality at work. We selected papers published until 07/28/2017 in databases or search engines: Medline, ClinicalTrials.gov, Google Scholar. |
Thirteen comparative clinical trials with placebo and four active comparators reported the efficacy of antidepressants on subjective measures of workplace impairment. Overall, antidepressant treatment has improved standardized measures of workplace functioning (for example, Sheehan Disability Scale work item). Evidence available suggests that antidepressant treatment improves workplace outcomes in MDD. The increase with other interventions may, additionally, facilitate the return to pre-morbid levels of functioning and return of patients to work (for example, lifestyle changes, cognitive-behavioral therapy, work-directed interventions, sleep normalization). |
Beiwinkel 20173636. Beiwinkel T, Eißing T, Telle NT, Siegmund-Schultze E, Rössler W. Effectiveness of a Web-Based Intervention in Reducing Depression and Sickness Absence: Randomized Controlled Trial. J Med Internet Res 2017; 19: e213. doi: 10.2196/jmir.6546. PMID: 28619701. https://doi.org/10.2196/jmir.6546...
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Clinical trial using the online tool “HelpID” based on cognitive behavioral therapy, mindfulness and counseling containing interactive content, videos, audios, graphics and others to promote education for depression, self-knowledge and relaxation, among others. The intervention was weekly, from 30 to 45 minutes. The Patient Health Questionnaire (PHQ9) and Beck Depression Inventory (BDI II) questionnaires were applied before, at the end of the 12 week intervention and after 24 weeks. |
180 participants were randomized into intervention group (n = 100, final adhesion of 31) and control (n = 80, final adhesion of 27). The control group received informative texts on depression. Both groups presented a significant reduction of absenteeism in −67.23%, P <.001 in the intervention group and −82.61%, P <.001 in the control group. There was no significant difference in absenteeism reduction between the two groups (P = 0.07). A significant difference between groups in favor of the intervention group was found for PHQ9 (P <0.001), which corresponds to a mean effect size. For those in BDI-II, a significant difference was found between the posttreatment groups (P = 0.004), which corresponds to a moderate effect size. In the intervention group, 63% (63/100) of the participants showed a reliable change of symptoms from baseline to post-intervention and were classified as responders. In the control group, 33% (27/80) were classified as responders. The difference in the reliable change of symptoms between the intervention and the control group was significant (p <0.001). This resulted in an NNT of 4.08. |
Hirsch 20173737. Hirsch A, Luellen J, Holder JM, Steinberg G, Dubiel T, Blazejowskyj A, et al. Managing Depressive Symptoms in the Workplace Using a Web-Based Self-Care Tool: A Pilot Randomized Controlled Trial. JMIR Res Protoc 2017; 6: e51. doi: 10.2196/resprot.7203. PMID: 28377368. https://doi.org/10.2196/resprot.7203...
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Clinical trial using myStrenght digital tool with content based on cognitive behavioral therapy, religion, mindfulness, mood monitoring and others. The intervention group accessed the content freely during the 26 weeks of the study. The control group received e-mails with educational content on depression. The Depression, Anxiety, and Stress Scale (Dass21) questionnaire was applied at the beginning of the intervention and after 14, 60 and 180 days. |
96 participated in the intervention group and 69 in the control group. The primary outcome of interest is the change in depression score over time. Both participants in the experimental study and active control experienced a reduction of depressive symptoms over time. Depressive symptoms, especially mild ones, tend to decrease, even without intervention, on the account of time. On average, study participants in the intervention group accessed the myStrength platform 6.09 times during the 26-week study period. Receiving mental health treatment, such as outpatient therapy or taking antidepressant medication, was an independent predictor of depression score reduction over time (P =.026). The main effect of time was statistically significant, which means that, overall, a reduction of 0.83 in the depression score was achieved at each time point (P = 0.002). This main effect finding is qualified by the interaction group x time (P <.001). Taking into account potential confounding factors, the experimental group experienced an accelerated course of reducing symptoms of depression to a factor 1.35 times faster than the control group. |
Sarfati 20173838. Sarfati D, Stewart K, Woo C, Parikh SV, Yatham LN, Lam RW. The effect of remission status on work functioning in employed patients treated for major depressive disorder. Ann Clin Psychiatry 2017; 29: 11-16. PMID: 27901522.
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Clinical trial that seeks to compare differences in productivity and functionality at work between intervention groups of patients with depression treated with escitalopram and eight weekly sessions of cognitive behavioral therapy by telephone vs. control group treated with escitalopram. The Montgomery-Åsberg Depression Rating Scale (Madrs), Employment Absence and Productivity Scale (Leaps), Work Performance Questionnaire (HPQ), and Sheehan Disability Scale (SDS) questionnaires were applied. |
Among the 99 randomized patients, 86 completed the 12-week study. Remission of symptoms, irrespective of treatment, was associated with significant improvement in work performance, by the Leaps productivity subscale, by the overall HPQ performance, and by the SDS work/school item; a non-significant trend (P = 0.08) was observed with the HPQ productivity subscale. Effect sizes indicate small to medium effects likely to be clinically significant. |
Imamura 20153939. Imamura K, Kawakami N, Furukawa TA, Matsuyama Y, Shimazu A, Umanodan R, et al. Does Internet-based cognitive behavioral therapy (iCBT) prevent major depressive episode for workers? A 12-month follow-up of a randomized controlled trial. Psychol Med 2015; 45:1907-17. doi: 10.1017/S0033291714003006. PMID: 25562115. https://doi.org/10.1017/S003329171400300...
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Clinical trial that investigated the preventive effect for depression in Japanese IT company workers from an online cognitive behavioral therapy program. Intervention group (n = 381) participated in six weekly sections of the online program, control group (n = 381) received e-mails with nonspecific monthly stress management tips over six months. To evaluate the incidence of depression after 6 and 12 months, the Beck Depression Inventory - I (BDI-II) and Kessler's Psychological Distress Scale (K6) questionnaires were used. |
At the end of six months, 272 (71.4%) participants in the intervention group and 320 (84.0%) of the control group completed the follow-up study. After 12 months, 239 (62.7%) participants from the intervention group and 272 (71.4%) from the control group completed the follow-up research. Dropout rates were significantly higher in the intervention group at both the six-month follow-up (p <0.01) and at the 12-month follow-up (p = 0.01). Participants in the intervention group had a significantly lower incidence than the control group at the six-month follow-up (p = 0.07) and a significantly lower incidence at the 12-month follow-up (p <0.01). The hazard ratio (HR) of major depression for the intervention group compared to the control group was 0.22 (95% CI 0.06-0.75) during the 12-month follow-up. At six months of follow-up, the relative risk (RR) of having major depression (MD) in the intervention group was 0.30 (p> 0.05). In the 12-month follow-up, the relative risk of having major depression in the intervention group was 0.20 (p <0.01); the number needed to achieve the prevention of one case of MD onset was 32 (95% CI 19-100). |
Lerner 20144040. Lerner D, Adler DA, Rogers WH, Chang H, Greenhill A, Cymerman E, et al. A randomized clinical trial of a telephone depression intervention to reduce employee presenteeism and absenteeism. Psychiatr Serv 2015; 66: 570-7. doi: 10.1176/appi.ps.201400350. PMID: 25726984. https://doi.org/10.1176/appi.ps.20140035...
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The study aimed to evaluate the improvement of the functionality at work in workers over 45 years of age with depression and with limitations at work. The intervention group was exposed to eight telephonic sessions of cognitive behavioral therapy of 50 minutes every two weeks with experienced psychologists. The control group received standard care of referral to the physician. A total of 380 participants completed the study. Patient Health Questionnaire-9 (PHQ-9), Primary Care Screener for Affective Disorder and Work Limitations Questionnaire (WLQ) were applied. |
At baseline, 39% of participants in the overall sample had persistent depressive disorder, 25% had major depression, and 36% had both. Among those with persistent depressive disorder and those with persistent depressive disorder and major depression, 73% (N = 192 of 264) had moderate symptoms and 27% (N = 72 of 264) had severe symptoms. The intervention group improved significantly in each outcome, and the improvements were significantly higher than those observed for the usual care group. The loss of labor productivity improved significantly by 44% (p <0.001) in the intervention group compared with 13% (p <0.001) in the usual care group. Improvements measured by the four WLQ work performance scales were significant in favor of the intervention group. Absences decreased 53% in the WFI group (p <0.001) versus 13% in the usual care group (p = 0.31) (p <0.001 for the difference in change). The mean severity scores for depression symptoms dropped by 51% (p <0.001) in the intervention group versus 26% (p <0.001) in the usual care group (p <0.001 for the difference in change). |
Volker 20154141. Volker D, Zijlstra-Vlasveld MC, Anema JR, Beekman AT, Brouwers EP, Emons WH, et al. Effectiveness of a blended web-based intervention on return to work for sick-listed employees with common mental disorders: results of a cluster randomized controlled trial. J Med Internet Res 2015; 17: e116. doi: 10.2196/jmir.4097. PMID: 25972279. https://doi.org/10.2196/jmir.4097...
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A clinical trial that evaluated, in workers with depression symptoms on leave for any disease for 4 to 26 weeks, the effects of an online intervention with content in five modules: psychoeducation, cognitive perception of return to work, problem-solving skills, management of pain and fatigue, prevention of relapse with the purpose of promoting partial or total return to work. The control group received usual care. The tool notifies via e-mail the occupational doctor that monitors and advises the worker during the leave. |
A total of 220 workers were allocated initially in the intervention group (n = 131) and control (n = 89). Return to work presented higher and earlier rates of return to work in the intervention group. Partial or total return of 84% (72/86) in the intervention group vs. 87.7% (114/130) in the control group and total early return to work with difference of 47 days in the intervention group compared to the control group; however, this difference was not statistically significant. |
Imamura 20154242. Imamura K, Kawakami N, Furukawa TA, Matsuyama Y, Shimazu A, Umanodan R, et al. Effects of an internet-based cognitive behavioral therapy intervention on improving work engagement and other work-related outcomes: an analysis of secondary outcomes of a randomized controlled trial. J Occup Environ Med 2015; 57: 578-84. doi: 10.1097/JOM.0000000000000411. PMID: 25749132. https://doi.org/10.1097/JOM.000000000000...
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762 IT workers were randomized into a clinical trial, which sought to evaluate the improvement of work engagement between intervention group exposed to a weekly online behavioral cognitive behavioral therapy program of 30 minutes in six modules vs. control group exposed to emails with simple stress management tips. After three and six months, work engagement was measured. The Utrecht Work Engagement Scale (Uwes), WHO Health and Work Performance Questionnaire (HPQ) and Beck Depression Inventory II (BDI-II) questionnaires were applied. |
At the end of three months, 270 (70.9%) participants from the intervention group and 336 (88.2%) from the control group completed the follow-up study. At the six-month follow-up, 272 (71.4%) participants from the intervention group and 320 (84.0%) from the control group completed the follow-up research. The program showed a significant effect on Uwes (P = 0.04), but at low intensity of effect: 0.11 (95% CI, −0.05 to 0.27) at three months of follow-up and 0.16 95% CI, 0.0007 to 0.32) at six months follow-up. The program showed a marginally significant effect on days of sick leave in the last three months (P = 0.07), with small effect sizes: −0.16 (95% CI −0.32 to 0.0003) at three-month follow-up and −0.14 (95% CI −0.30 to 0.02) at the six-month follow-up. The conclusion of the study was positive results in the work engagement through the program, effect partially explained with the improvement of depression symptoms. |
Kröger 20154343. Kröger C, Bode K, Wunsch EM, Kliem S, Grocholewski A, Finger F. Work-related treatment for major depressive disorder and incapacity to work: preliminary findings of a controlled, matched study. J Occup Health Psychol 2015; 20: 248-58. doi: 10.1037/a0038341. PMID: 25402222. https://doi.org/10.1037/a0038341...
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26 workers on leave due to depression were divided between usual behavioral cognitive therapy (control group, n = 13) and work-related cognitive behavioral therapy. Each group received around 24 sessions of psychotherapy. The aim of the study was to compare the improvement of depression symptoms and absenteeism between the groups. Beck Depression Inventory (BDI), Life Satisfaction Questionnaire (FLZ) and Symptom-Checklist 90-Revised (GSI) questionnaires were applied. |
All participants reported a BDI score ≥ 15 points. The mean pre-treatment BDI score was 20.58 (SD ± 5.20), indicating a moderate level of depression. Absenteeism was significantly reduced in both types of treatment. There was no difference between groups in terms of early partial return to work (p = 0.722). Eight versus six employees in the intervention and control group, respectively, returned to the work place on a part-time basis. For both types of treatment, BDI and GSI scores decreased significantly over time, while FLZ scores increased significantly. |
Geraedts 20144444. Geraedts AS, Kleiboer AM, Twisk J, Wiezer NM, van Mechelen W, Cuijpers P. Long-term results of a web-based guided self-help intervention for employees with depressive symptoms: randomized controlled trial. J Med Internet Res 2014; 16: e168. doi: 10.2196/jmir.3539. PMID: 25008127. https://doi.org/10.2196/jmir.3539...
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The clinical trial tested the effects on absenteeism and symptoms of depression in workers not on leave for depression from an online Happy @ Work self-help program compared to usual care. This tool is based on problem-solving treatment (PST) and cognitive therapy (CT) and a guideline to help employees prevent work-related stress. The Trimbos and iMTA Questionnaire on Costs Associated with Psychiatric Illness (TiCP), Short Form Health and Labor Questionnaire (SFHLQ), Center for Epidemiologic Studies Depression Scale (CESD), Maslach Burnout InventoryGeneral Scale (MBI), WHO Health and Work Performance Questionnaire (HPQ) were applies, among others. |
A total of 231 participants were included in the study, of which 116 were in the intervention group and 115 in the control group. Of the 231 participants, 10 (4.3%) used medication without psychological treatment, 24 (10.4%) received psychological treatment, but no medication, and four participants (1.7%) used both medications and received psychological treatment in the beginning of the study. All participants had improved depressive symptoms and this improvement was sustained over time. However, the estimated overall mean difference between groups over time was not significant. There were improvements between baseline and posttreatment assessment in the secondary outcomes, and these improvements were sustained over time, but there were no significant differences between groups over time. The total between the effect sizes of the group for secondary outcomes was small. The result of absenteeism was expressed in the duration of absenteeism during the period between two evaluations. Therefore, it is not possible to study whether there was an increase or decrease in the duration of absenteeism over time, but only the differences between the groups regarding the duration of absenteeism can be examined. The estimated overall mean difference between groups over time was not significant. |
Tan 20144545. Tan L, Wang MJ, Modini M, Joyce S, Mykletun A, Christensen H, Harvey SB. Preventing the development of depression at work: a systematic review and meta-analysis of universal interventions in the workplace. BMC Med 2014; 12: 74. doi: 10.1186/1741-7015-12-74. PMID: 24886246. https://doi.org/10.1186/1741-7015-12-74...
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Systematic review of clinical trials of any intervention in an occupational setting for the prevention of depression. Articles were searched in Medline, PsycInfo and Embase databases. |
Most of the included studies used cognitive behavioral therapy (CBT) techniques. The overall standardized mean difference (SMD) between the intervention and control groups was 0.16 (95% CI 0.07, 0.24, P = 0.0002), indicating a small positive effect. A separate analysis using only CBT-based interventions generated a significant SMD of 0.12 (95% CI 0.02, 0.22, P = 0.01). The results indicate that a number of different depression prevention programs produce small positive effects in the workplace. When analyzed separately, CBT-based interventions significantly reduced levels of depressive symptoms among workers. These results demonstrate that appropriate evidence-based interventions in the workplace should be part of efforts to prevent the development of depression. In conclusion, there is good quality evidence that universal mental health interventions can reduce the overall level of depression symptoms in workers. Specifically, CBT-based interventions in the workplace are effective in reducing universal symptoms for depression. Further research is required to determine the extent to which such interventions can prevent new cases of depression and establish economic and practical strategies for large-scale implementation. Overall, the results of this review provide support for occupational mental health interventions and raise the imperative that depression should no longer be ignored in health promotion programs in the workplace. |
Phillips 20144646. Phillips R, Schneider J, Molosankwe I, Leese M, Foroushani PS, Grime P, et al. Randomized controlled trial of computerized cognitive behavioural therapy for depressive symptoms: effectiveness and costs of a workplace intervention. Psychol Med 2014; 44: 741-52. doi: 10.1017/S0033291713001323. PMID: 23795621. https://doi.org/10.1017/S003329171300132...
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Clinical trial that evaluated the effects on depression symptoms in workers of an online self-help program based on cognitive behavioral therapy, lasting five weeks and evaluating the effects after 6 and 12 weeks. The program has five modules of one hour each and weekly. The Work and Social Adjustment Scale (WSAS) and Patient Health Questionnaire-9 (PHQ-9) questionnaires were used. |
In the experimental and control groups, depression scores improved in six weeks, but the loss of participants was high. There was no evidence of a difference in the median effect of MoodGYM treatment on WSAS, nor for a difference in any of the secondary outcomes. |
Lam 20134747. Lam RW, Parikh SV, Ramasubbu R, Michalak EE, Tam EM, Axler A, et al. Effects of combined pharmacotherapy and psychotherapy for improving work functioning in major depressive disorder. Br J Psychiatry 2013; 203: 358-65. doi: 10.1192/bjp.bp.112.125237. PMID: 24029535. https://doi.org/10.1192/bjp.bp.112.12523...
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The clinical trial sought to compare improvement in symptoms of depression and functionality at work among workers with major depression with participants in a group exposed to cognitive behavioral therapy (CBT) by phone + escitalopram and a group exposed only to escitalopram. The Montgomery-Asberg Depression Rating Scale (Madrs), Sheehan Disability Scale (SDS), Lam Employment Absence and Productivity Scale (Leaps), Health and Work Performance Questionnaire (HPQ) were applied. |
After randomization, 48 were allocated to the telephone CBT group and 51 to the escitalopram group. There were 40 (83%) patients evaluated at the outcome of 12 weeks for the CBT + escitalopram group and 46 (90%) for the escitalopram group. There was significant improvement in Madrs change scores within each treatment condition, with large start point effect sizes at the end. However, there was no significant difference between groups. In the analysis, response rates were 63% in the CBT + escitalopram group and 61% in the escitalopram group, and remission rates were 56% and 53%, respectively (p = 0.74). The SDS item of work/function showed improvement within each treatment condition, but there were no significant differences between the treatment conditions. The other work scales showed significant differences between the treatment conditions favoring CBT + escitalopram. |
Hees 20134848. Hees HL, de Vries G, Koeter MW, Schene AH. Adjuvant occupational therapy improves long-term depression recovery and return-to-work in good health in sick-listed employees with major depression: results of a randomised controlled trial. Occup Environ Med 2013; 70: 252-60. doi: 10.1136/oemed-2012-100789. PMID: 23117218. https://doi.org/10.1136/oemed-2012-10078...
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Clinical trial evaluating the effects of sessions with occupational therapists on return to work of workers on leave for at least eight weeks due to major depression compared to workers who received usual care. A total of 18 sessions, nine individual, eight in group and one with the employer were applied in the intervention group. The outcomes measured were the rates and delay of partial or total return to work, absenteeism and variation of the depression symptoms. The Hamilton Rating Scale for Depression (HRSD) and Utrecht Coping List (UCL) questionnaires were applied, among others. |
Both groups decreased significantly in their hours of absenteeism (p <0.001), with the largest decrease between 6 and 12 months (p <0.001). However, there were no significant differences between the groups. Over time, participants in the intervention group had greater improvement in depression symptoms than in the control group, both in terms of severity (p = 0.03) and long-term remission (HRSD ≤ 7, OR = 1, 8, 95% CI 1.0 to 3.3). In addition, the percentage of participants achieving sustainable remission - defined as remission for ≥ 6 months - was higher in the intervention group (92%) than in the control group (69%; p = 0.04). Both groups decreased significantly in their work limitations (all three WLQ scales p <0.001), with the greatest decrease between 6 and 12 months (Output: p = 0.01, Time Management: p = 0.02, Mental/Interpersonal: p = 0.02). Likewise, both groups increased the work efficiency (p <0.001), with the highest increase between 6 and 12 months (p = 0.01). However, no significant differences were found between groups for these measures. |
Vlasveld 20134949. Vlasveld MC, van der Feltz-Cornelis CM, Adèr HJ, Anema JR, Hoedeman R, van Mechelen W, et al. Collaborative care for sick-listed workers with major depressive disorder: a randomised controlled trial from the Netherlands Depression Initiative aimed at return to work and depressive symptoms. Occup Environ Med 2013; 70: 223-30. doi: 10.1136/oemed-2012-100793. PMID: 23112266. https://doi.org/10.1136/oemed-2012-10079...
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The clinical trial sought to evaluate the effectiveness of a collaborative care program to promote return to work (RTW) in workers on leave for 4 to 12 weeks for major depression compared to usual care. The intervention involves 6 to 12 sessions of problem-solving therapy, use of antidepressants in selected cases, self-help manuals, and meetings between worker and employer. The Patient Health Questionnaire (PHQ-9) was used. |
126 participants were included in the study and were randomized to either the usual care group (N = 61) or the collaborative care group (N = 65). Participants in collaborative care did not differ significantly from usual care participants in the odds of not achieving remission or response from depression (p> 0.05). For the participants who achieved remission, the mean time to first remission was 6.5 months in the collaborative care group (N = 27/65) and 7.9 months in the usual care group (N = 29/61). Within one year of follow-up, 64.6% of collaborative care participants and 59.0% of usual care participants had achieved long-lasting and complete RTW. The mean duration of complete and long-term RTW, calculated from day of randomization, was 190 days (DP of 120 days) in the collaborative care group and 210 days (DP of 124 days) in the usual care group. |
Raiskila 20135050. Raiskila T, Blanco Sequeiros S, Kiuttu J, Kauhanen ML, Läksy K, Vainiemi K, et al. The Impact of an Early Eclectic Rehabilitative Intervention on Symptoms in First Episode Depression among Employed People. Depress Res Treat 2013; 2013: 926562. doi: 10.1155/2013/926562. PMID: 24324883. https://doi.org/10.1155/2013/926562...
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The study evaluated the effectiveness of a multiprofessional program involving psychotherapist, psychiatrist, social worker, among others, in order to promote support for professional and personal stressors. The program offers courses and sessions based on cognitive behavioral therapy and principles of psychodynamics, workplace visits and assessments associated with employer support and occupational health service, family support with convening family members. The Beck Depression Inventory (BDI) and the Structured Clinical Interview for DSMIV (SCID I and II) were applied. |
A total of 355 individuals were referred to the project, and 283 of them were randomized to the intervention (N = 142) and control (N = 141) groups. The selected workers had BDI scores higher than 9. According to SCID I interviews, 34.3% of participants in the intervention group (N = 134) presented mild depression, 59.0% moderate and 6.7% severe depression at the beginning of the study. In the control group (N = 100), the respective rates were 49.0%, 45.0% and 6.0%. The mean BDI score at the beginning of the study was 20.8 in the intervention group and 19.3 in the control group and, after one year of follow-up, 9.1 and 8.8, respectively. The mean reduction in BDI scores in the intervention group was 11.6 and 10.8 in the control group. The decrease was statistically significant in both groups (P <0.001). The only significant difference between the study groups was the decrease in BDI scores above 9 points during the one-year follow-up period, which occurred in two-thirds of the intervention group and half of the control group (P = 0.013). |
Ahola 20125151. Ahola K, Vuori J, Toppinen-Tanner S, Mutanen P, Honkonen T. Resource-enhancing group intervention against depression at workplace: who benefits? A randomised controlled study with a 7-month follow-up. Occup Environ Med 2012; 69: 870-6. doi: 10.1136/oemed-2011-100450. PMID: 22718708. https://doi.org/10.1136/oemed-2011-10045...
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The study sought to promote the prevention of active workers through skills training sessions. The intervention consisted of four half-day sessions, which were held for one or two weeks. The skills involved principles of lifelong learning, organizational change management practice, social conflict resolution, career management, among others. The Beck Depression Inventory (BDI) questionnaire and the Job Content Questionnaire were applied. |
A total of 43 medium and large organizations were contacted and had the opportunity to participate in a study about an intervention program. The final study population consisted of 566 people (79%), with 296 (80%) in the intervention group and 270 (77%) in the comparison group. In the follow-up, the odds of depression were lower in the intervention group (OR = 0.40 95% CI 0.19 to 0.85) than in the comparison group when adjusted for initial depressive symptoms, work stress, and demographic data. The odds of depression among those with stress at work (OR = 0.15, 95% CI 0.03 to 0.81) were lower after the intervention. There was no statistically significant effect among those with depressive symptoms at baseline. |
Lerner 20125252. Lerner D, Adler D, Hermann RC, Chang H, Ludman EJ, Greenhill A, et al. Impact of a work-focused intervention on the productivity and symptoms of employees with depression. J Occup Environ Med 2012; 54: 128-35. doi: 10.1097/JOM.0b013e31824409d8. PMID: 22252528. https://doi.org/10.1097/JOM.0b013e318244...
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The clinical trial sought to evaluate the efficacy of a multifaceted telephonic program for workers with depression and lost productivity at work. The program involves coaching, coordination of care with negotiation of a therapeutic plan, education about depression and its treatment, referral to medical treatment, use of cognitive behavioral therapy strategies. The Work Limitations Questionnaire (WLQ) and Patient Health Questionnaire 9 (PHQ-9) questionnaires were applied. |
79 workers were randomized into the control group (27) and the intervention group (52). All results improved significantly (p <0.01) in the intervention group. The results from the control group were worse compared to baseline or did not improve significantly. The magnitude of the improvement in all outcomes was significantly higher in the intervention group (p <0.01). Within the intervention group, job performance improved an average of 18.1 points for time management, 10.9 points for physical tasks, 11.8 points for interpersonal mental work tasks and 14.2 points for exit tasks. These represent between 20% and 50% of the initial mean of the WLQ scale. The loss of work productivity for the intervention group declined from 10.3% (SD = 4.3) to 6.8% (SD = 4.3), for an average improvement of 3.5 percentage points (p < 0.01). Absence in the intervention group improved from 1.7 (SD = 1.7) to 1.0 day (SD = 1.2 p <0.01). Loss of productivity due to absences improved 7.1% (p <0.01). |
Furukawa 20125353. Furukawa TA, Horikoshi M, Kawakami N, Kadota M, Sasaki M, Sekiya Y, et al. Telephone cognitive-behavioral therapy for subthreshold depression and presenteeism in workplace: a randomized controlled trial. PLoS One 2012; 7: e35330. doi: 10.1371/journal.pone.0035330. PMID: 22532849. https://doi.org/10.1371/journal.pone.003...
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Clinical trial that sought to evaluate the effectiveness of an eight-session cognitive behavioral therapy program by telephone in active workers with the purpose of reducing presenteeism and symptoms of depression. In both the control group and the intervention group, a worker assistance program for diagnosis and stress reduction was available. The K6, Health and Work Performance Questionnaire (HPQ) and Beck Depression Inventory II (BDI-II) were used. |
The planned sample size was 108 per group, but the test was interrupted early because of the low participation rate. In total, 118 individuals were randomized, of which 58 were in the intervention group and 60 in the control group. The BDI-II scores decreased from the mean of 17.3 at the baseline to 11.0 in the intervention group and to 15.7 in the control group after four months (p <0.001), with effect size at 0.69 (95% CI 0.32 to 1.05). However, there was no statistically significant reduction in absolute or relative presenteeism. |
Sandahl 20115454. Sandahl C, Lundberg U, Lindgren A, Rylander G, Herlofson J, Nygren A, et al. Two forms of group therapy and individual treatment of work-related depression: a one-year follow-up study. Int J Group Psychother 2011; 61: 539-55. doi: 10.1521/ijgp.2011.61.4.538. PMID: 21985258. https://doi.org/10.1521/ijgp.2011.61.4.5...
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A sample of 120 office workers on prolonged leave of over 90 days due to work-related depression was distributed to focal psychodynamic therapy (FGT), cognitive therapy (CGT) or a comparison group (CC). The study sought to evaluate the effectiveness of the intervention in promoting return to work. |
In the six-month telephone interview, 74% of the patients in the therapy group reported that they were satisfied or very satisfied with the group therapy treatments, and 75% reported that they felt better or recovered. There was no difference in this respect between the two group treatments. In the 12-month follow-up, 69% reported that they were working part-time or longer. The pattern of return to work differed somewhat between groups, but this can be explained by different patterns of inclusion. Therefore, the conclusion was that even with regard to return to work, there was no difference between the three treatment conditions. |
Lexis 20115555. Lexis MA, Jansen NW, Huibers MJ, van Amelsvoort LG, Berkouwer A, Tjin A Ton G, et al. Prevention of long-term sickness absence and major depression in high-risk employees: a randomised controlled trial. Occup Environ Med 2011; 68: 400-7. doi: 10.1136/oem.2010.057877. PMID: 20924024. https://doi.org/10.1136/oem.2010.057877...
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Clinical trial sought to evaluate the effectiveness of 10-12 sessions of psychotherapy based on principles of problem-solving therapy and cognitive behavioral therapy in the prevention of long-term absenteeism in high-risk workers with symptoms of depression. The Balansmeter, Hospital Anxiety and Depression Scale (HAD Scale), Short Form Health Survey (SF-36), Job Content Questionnaire, among others, were applied. |
A total of 139 employees were included in the study and randomized to the intervention group (n = 69) or the control group (n = 70). A significant difference in the total duration of absence due to illness was found between the intervention (27.5 days) and the control group (50.8 days) at the 12-month follow-up with a 46% reduction (p = 0.017). The intervention group showed a non-significantly lower proportion of long-term absenteeism episodes compared to the control group (p = 0.127) at the 12-month follow-up. Regarding the complaints of depression, significant differences were observed after 6 and 12 months of follow-up in favor of the intervention group, with a reduction of 19.2% and 19.8%, respectively, with a number needed to treat (NNT) in 5.2 (95% CI 2.7 to 55.5) and 5.0 (95% CI 2.7 to 32.1), respectively. |
Farzanfar 20115656. Farzanfar R, Locke SE, Heeren TC, Stevens A, Vachon L, Thi Nguyen MK, et al. Workplace telecommunications technology to identify mental health disorders and facilitate self-help or professional referrals. Am J Health Promot 2011; 25: 207-16. doi: 10.4278/ajhp.100118-QUAN-14. PMID: 21192751. https://doi.org/10.4278/ajhp.100118-QUAN...
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Clinical trial comparing the efficacy of an automated screening program associated with psychoeducation, counseling for self-help measures, and specialized follow-up versus isolated, telephone-based screening for workers with stress and untreated symptoms. The questionnaires used were Work Limitation Questionnaire, Medical Outcomes Questionnaire Short Form-12, Patient Health Questionnaire 9, Perceived Stress Scale 4 and WHO-Five Well-being Index. |
A total of 164 workers were randomized into the intervention (87) and control (77) groups. Those in the intervention group showed a significantly greater reduction in depression (p ≤ 0.05) at three months, a non-significant improvement in overall mental health at six months (p ≤ 0.10), as well as a significantly greater improvement in subscale of the work limitation questionnaire, at the mental-interpersonal scale (p ≤ 0.05) at three months and at the time and scheduling scale (p ≤ 0.05) at six months. Based on the analysis, participants in the intervention group found the system easy to use (84% reporting very easy or slightly easy to use), friendly (80% very or slightly friendly), appropriately rhythmic (67%) and informative (76% reporting very or slightly informative). In addition, 65% reported that the system was very or partially useful and 47% agreed that the system reduced the time spent at the doctor. |
Bee 20105757. Bee PE, Bower P, Gilbody S, Lovell K. Improving health and productivity of depressed workers: a pilot randomized controlled trial of telephone cognitive behavioral therapy delivery in workplace settings. Gen Hosp Psychiatry 2010; 32: 337-40. doi: 10.1016/j.genhosppsych.2010.01.006. PMID: 20430241. https://doi.org/10.1016/j.genhosppsych.2...
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Clinical trial evaluated the effects of telephone sessions of cognitive behavioral therapy on symptoms of depression and productivity in workers with symptoms of depression and history of absenteeism in the last ten months. The questionnaires applied were the 34-item Clinical Outcomes in Routine Evaluation Outcome measure (Core-OM), Hospital Anxiety & Depression Scale (Hads), Work and Social Adjustment Scale (WSAS) and WHO Work Performance Questionnaire. |
53 workers were randomized, of which 26 were in the intervention group. Although the clinical results were not statistically significant, the direction of the effect favored the intervention, which was associated with moderate effects sizes in clinical outcomes and in the labor productivity score. |
Martin 20095858. Martin A, Sanderson K, Cocker F. Meta-analysis of the effects of health promotion intervention in the workplace on depression and anxiety symptoms. Scand J Work Environ Health 2009; 35: 7-18. PMID: 19065280.
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Systematic review and meta-analysis of published clinical trials between 1997 and 2007 to evaluate the effects of occupational health promotion programs on symptoms of depression or anxiety. The intervention aimed at mental health, directly or indirectly, through a known risk factor for depression or anxiety. The revised interventions were limited to those delivered at the workplace. |
In all, 22 studies met the inclusion criteria, with a total sample of 3,409 post-intervention workers, and 17 of these studies were included in the meta-analysis, representing 20 intervention-control comparisons. The pooled results indicated small but positive overall effects of interventions for symptoms of depression [SMD 0.28, 95% confidence interval (CI 95%), 0.12-0.44] and anxiety [SMD 0.29, 95% CI 0.06-0.51), but no effect on composite mental health measures [SMD 0.05, 95% CI 0.03-0.13). Interventions that included a direct focus on mental health had benefit in the symptoms of depression and anxiety, as well as interventions with an indirect focus on risk factors. |
Nakao 20075959. Nakao M, Nishikitani M, Shima S, Yano E. A 2-year cohort study on the impact of an Employee Assistance Programme (EAP) on depression and suicidal thoughts in male Japanese workers. Int Arch Occup Environ Health 2007; 81: 151-7. PMID: 17492306.
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A cohort study of 283 Japanese workers exposed to a worker assistance program (EAP) aimed at improving the symptoms of depression. The program offered psychological counseling by email or telephone, which was free and anonymous, and referral to a psychiatric clinic affiliated with the institute. In addition, work-related mental health seminars were held for all employees five times a year. The Hamilton Depression Scale (HAM-D) and Job Content Questionnaire (JCQ) questionnaires were applied. |
In the EAP group, scores on the full-scale HAM-D decreased significantly during the study. The following results were obtained for the total sample: HAM-D scores decreased by 149 people (53%), remained unaltered in 27 people (10%) and increased in 107 people (38%). In the EAP group, changes in the HAM-D scores for suicidal thoughts, agitation, psychomotor retardation, guilt, and depressed mood were significant. Specifically, 22 men in the EAP group responded positively to the suicidal thoughts item of HAM-D at baseline. The total scores of these 22 subjects decreased significantly over the two-year period, and 19 subjects (86%) reported no suicidal thoughts at the end of the study period. The total HAM-D at the beginning of the study did not differ significantly between the PAD group and the reference group, and there were no significant changes in the total scores and items in the reference group during the intervention period. The three JCQ scores at baseline were not significantly different between the EAP group and the reference group. |
Wang 20076060. Wang PS, Simon GE, Avorn J, Azocar F, Ludman EJ, McCulloch J, Petukhova MZ, et al. Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: a randomized controlled trial. JAMA 2007; 298: 1401-11. PMID: 17895456.
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A clinical trial that sought to evaluate the effectiveness of a telephone depression screening and monitoring program for workers with depression. The structured telephone intervention program systematically evaluated treatment needs, facilitated entry into personal treatment (psychotherapy and antidepressant medication), monitored and supported adherence to treatment, and offered a structured psychotherapeutic intervention by telephone. The Quick Inventory of Depressive Symptomatology (QIDS-SR) and WHO Health and Productivity Questionnaire (HPQ) questionnaires were applied. |
QIDS-SR scores were significantly lower at intervention than the usual care group at 6 and 12 months. The proportion whose symptoms improved substantially (50% improvement in QIDS-SR) was also significantly higher among interventions than usual care, but not until the 12-month evaluation (30.9% vs. 21.6%, OR = 1.7). The proportion of participants with recovery (QIDS-SR ≤ 5) was also significantly higher in the intervention than the usual care group, but not before 12 months (26.2% vs. 17.7%, OR = 1.7). The scores in the effectiveness measure of hours worked were significantly higher in the intervention than in the usual care group at 6 and 12 months. This overall effect was due to significant improvements in job retention (92.6% vs. 88.0% in 12 months, OR = 1.7) and hours worked among the participants. Participants in the intervention group were significantly more likely than those in usual care to receive any special mental health treatment (OR = 1.6), but somewhat less likely to receive any treatment of depression in primary or non-medical care (OR = 0.6-0.7). The average number of treatment contacts in all occupations (including care manager contacts) was almost twice as high in the intervention versus the usual care group (12.7 vs. 6.5, t = 5.7, p <0.001). |
Schene 20076161. Schene AH, Koeter MW, Kikkert MJ, Swinkels JA, McCrone P. Adjuvant occupational therapy for work-related major depression works: randomized trial including economic evaluation. Psychol Med 2007; 37: 351-62. PMID: 17112401.
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Clinical trial that sought to evaluate the effects of occupational therapy added to the usual care in workers with depression and absenteeism. The intervention consists of multiple phases seeking to clarify the activity of the job, promote preparation for reintegration to work, monitor the progress of return to work and advise on difficulties of adaptation. The Beck Depression Inventory (BDI) and the Questionnaire Organization Stress (QOS) were used. |
The percentage of patients who met the DSM-IV criteria for Major Depressive Episode decreased from 100% to 29% in the control group and to 44% in the intervention group. This recovery was statistically significant (p = 0.000), particularly in the first six months (p = 0.007), but not in the following six months (p = 0.23). The total BDI score decreased from 23.6 to 14.0 for the control group and from 27.1 to 12.3 for the intervention group, with significant interaction (p = 0.015), which did not occur in the 12 months (p = 0.950), but emerged between months 13 and 42 (p = 0.032). The time to return to work was measured between the groups. In the intervention group, the mean time to return to work was 207 days. 299 days in the control group, with a relative risk of RR = 2.71 (95% CI, 1.16-6.29, p = 0.01). |
Mino 20066262. Mino Y, Babazono A, Tsuda T, Yasuda N. Can stress management at the workplace prevent depression? A randomized controlled trial. Psychother Psychosom 2006; 75: 177-82. PMID: 16636633.
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The clinical trial sought to evaluate the effectiveness of a stress reduction program in preventing depression in workers who engaged in high-stress activities. The stress management program included lectures on stress perception, measures to address it, stress management records, and e-mail counseling. The General Health Questionnaire (GHQ), Center for Epidemiologic Study for Depression (CES-D), Questionnaire of Work-Related Stress and Effort-Reward Imbalance Questionnaire were used. |
58 workers were randomized into intervention group (28) and control group (30). In the intervention group, a significant improvement in the depressive symptoms was observed, compared to the control group through the CES-D questionnaire. In the multiple regression analysis, the effect of stress control on depressive symptoms at follow-up was significant (p = 0.041). |
Smith 20026363. Smith JL, Rost KM, Nutting PA, Libby AM, Elliott CE, Pyne JM. Impact of primary care depression intervention on employment and workplace conflict outcomes: is value added? J Ment Health Policy Econ 2002; 5: 43-9. PMID: 12529569.
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The clinical trial evaluated the effects of depression treatment offered by 12 primary care centers on reducing rates of unemployment and interpersonal conflict at work in workers with depression. Primary care physicians worked on providing treatment for depression and nurses worked on monitoring symptoms and adherence. Of the 262 patients in the baseline sample eligible for this analysis, 219 (83.6%) were followed up at one year. |
The intervention significantly increased subsequent employment in one year by 10.1% (p = 0.04, CI 90% 2.8-17.4%), reduced unemployment by 5.8% (CI 90% 1.6 −10.0%) and underemployment at 4.3% (CI 90% 1.2-7.4%). Of the difference of 10.1% in employment between intensive and usual care patients in one year, 3.4 percentage points are explained by the intervention. The additional 6.7 percentage points represents the ability to intervene to reduce the length of the periods of unemployment/underemployment among those who reported unemployment/underemployment in six months. Among those employed in one year, intensive care patients were significantly less likely than usual patients to report workplace conflicts in the following year (8.1% vs. 18.9%, p = 0.04). |