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BACKGROUND: Work disability such as sickness absence is common in people with depression. OBJECTIVES: To evaluate the effectiveness of interventions aimed at reducing work disability in employees with depressive disorders. SEARCH METHODS: We searched CENTRAL (The Cochrane Library), MEDLINE, Embase, CINAHL, and PsycINFO until April 4th 2020. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and cluster-RCTs of work-directed and clinical interventions for depressed people that included days of sickness absence or being off work as an outcome. We also analysed the effects on depression and work functioning. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted the data and rated the certainty of the evidence using GRADE. We used standardised mean differences (SMDs) or risk ratios (RR) with 95% confidence intervals (CI) to pool study results in studies we judged to be sufficiently similar. MAIN RESULTS: In this update, we added 23 new studies. In total, we included 45 studies with 88 study arms, involving 12,109 participants with either a major depressive disorder or a high level of depressive symptoms. Risk of bias The most common types of bias risk were detection bias (27 studies) and attrition bias (22 studies), both for the outcome of sickness absence. Work-directed interventions Work-directed interventions combined with clinical interventions A combination of a work-directed intervention and a clinical intervention probably reduces days of sickness absence within the first year of follow-up (SMD -0.25, 95% CI -0.38 to -0.12; 9 studies; moderate-certainty evidence). This translates back to 0.5 fewer (95% CI -0.7 to -0.2) sick leave days in the past two weeks or 25 fewer days during one year (95% CI -37.5 to -11.8). The intervention does not lead to fewer persons being off work beyond one year follow-up (RR 0.96, 95% CI 0.85 to 1.09; 2 studies, high-certainty evidence). The intervention may reduce depressive symptoms (SMD -0.25, 95% CI -0.49 to -0.01; 8 studies, low-certainty evidence) and probably has a small effect on work functioning (SMD -0.19, 95% CI -0.42 to 0.06; 5 studies, moderate-certainty evidence) within the first year of follow-up. Stand alone work-directed interventions A specific work-directed intervention alone may increase the number of sickness absence days compared with work-directed care as usual (SMD 0.39, 95% CI 0.04 to 0.74; 2 studies, low-certainty evidence) but probably does not lead to more people being off work within the first year of follow-up (RR 0.93, 95% CI 0.77 to 1.11; 1 study, moderate-certainty evidence) or beyond (RR 1.00, 95% CI 0.82 to 1.22; 2 studies, moderate-certainty evidence). There is probably no effect on depressive symptoms (SMD -0.10, 95% -0.30 CI to 0.10; 4 studies, moderate-certainty evidence) within the first year of follow-up and there may be no effect on depressive symptoms beyond that time (SMD 0.18, 95% CI -0.13 to 0.49; 1 study, low-certainty evidence). The intervention may also not lead to better work functioning (SMD -0.32, 95% CI -0.90 to 0.26; 1 study, low-certainty evidence) within the first year of follow-up. Psychological interventions A psychological intervention, either face-to-face, or an E-mental health intervention, with or without professional guidance, may reduce the number of sickness absence days, compared with care as usual (SMD -0.15, 95% CI -0.28 to -0.03; 9 studies, low-certainty evidence). It may also reduce depressive symptoms (SMD -0.30, 95% CI -0.45 to -0.15, 8 studies, low-certainty evidence). We are uncertain whether these psychological interventions improve work ability (SMD -0.15 95% CI -0.46 to 0.57; 1 study; very low-certainty evidence). Psychological intervention combined with antidepressant medication Two studies compared the effect of a psychological intervention combined with antidepressants to antidepressants alone. One study combined psychodynamic therapy with tricyclic antidepressant (TCA) medication and another combined telephone-administered cognitive behavioural therapy (CBT) with a selective serotonin reuptake inhibitor (SSRI). We are uncertain if this intervention reduces the number of sickness absence days (SMD -0.38, 95% CI -0.99 to 0.24; 2 studies, very low-certainty evidence) but found that there may be no effect on depressive symptoms (SMD -0.19, 95% CI -0.50 to 0.12; 2 studies, low-certainty evidence). Antidepressant medication only Three studies compared the effectiveness of SSRI to selective norepinephrine reuptake inhibitor (SNRI) medication on reducing sickness absence and yielded highly inconsistent results. Improved care Overall, interventions to improve care did not lead to fewer days of sickness absence, compared to care as usual (SMD -0.05, 95% CI -0.16 to 0.06; 7 studies, moderate-certainty evidence). However, in studies with a low risk of bias, the intervention probably leads to fewer days of sickness absence in the first year of follow-up (SMD -0.20, 95% CI -0.35 to -0.05; 2 studies; moderate-certainty evidence). Improved care probably leads to fewer depressive symptoms (SMD -0.21, 95% CI -0.35 to -0.07; 7 studies, moderate-certainty evidence) but may possibly lead to a decrease in work-functioning (SMD 0.5, 95% CI 0.34 to 0.66; 1 study; moderate-certainty evidence). Exercise Supervised strength exercise may reduce sickness absence, compared to relaxation (SMD -1.11; 95% CI -1.68 to -0.54; one study, low-certainty evidence). However, aerobic exercise probably is not more effective than relaxation or stretching (SMD -0.06; 95% CI -0.36 to 0.24; 2 studies, moderate-certainty evidence). Both studies found no differences between the two conditions in depressive symptoms. AUTHORS' CONCLUSIONS: A combination of a work-directed intervention and a clinical intervention probably reduces the number of sickness absence days, but at the end of one year or longer follow-up, this does not lead to more people in the intervention group being at work. The intervention may also reduce depressive symptoms and probably increases work functioning more than care as usual. Specific work-directed interventions may not be more effective than usual work-directed care alone. Psychological interventions may reduce the number of sickness absence days, compared with care as usual. Interventions to improve clinical care probably lead to lower sickness absence and lower levels of depression, compared with care as usual. There was no evidence of a difference in effect on sickness absence of one antidepressant medication compared to another. Further research is needed to assess which combination of work-directed and clinical interventions works best.

Objectives: This study aims to investigate the most important factors facilitating a return to work after sick leave due to depression from the perspectives of patients, supervisors and occupational physicians. Methods: Concept mapping was used to develop a conceptual framework. Using purposive sampling, 32 participants representing Employees, supervisors and occupational physicians, were asked to formulate statements on what enables patients with sick leave due to depression to return to work. A total of 41 participants rated and grouped the statements. Data were analyzed using the statistical program Ariadne. Results: The concept mapping yielded 60 statements that consisted of promoting factors for return to work. Based on these statements, three meta-clusters and eight clusters were identified. The three meta-clusters consisted of work-related, person-related and healthcarerelated clusters. The work-related meta-cluster comprised of "Adaptation of work", "Understanding and support in the workplace" and "Positive work experiences". The personrelated meta-cluster encompassed "Positive and valid self-perception", "Competence in self management", "Positive level of energy", and "Balanced home/work environment". The healthcare-related meta-cluster was composed of "Supportive healthcare". Stakeholder groups differ in opinion, in what they see as most important for return to work. Limitations: The low number of participants and the high educational level of participants are a limitation for generalization of the findings. Conclusions: The study generated different statements that stakeholders consider important for return to work after sick leave due to depression. These findings can be used as a checklist for coordination of the return to work process. Differences in opinion regarding what stakeholders see as most important for return to work should receive special consideration during the reintegration process. (C) 2011 Elsevier B.V All rights reserved

Contains fulltext : 154785.PDF (Publisher’s version ) (Open Access) OBJECTIVE: Medical certification is one of the basic administrative mechanisms used by social policies aimed at income protection. The assessment of work disability is central to the income protection application. Yet, there is evidence suggesting that determining work disability related to mental disorders is challenging. Although essential to the disability application process, few studies have looked at physician and other clinician experiences with the process. However, this type of information is critical to developing processes to support providers who participate in the assessments. This purpose of this paper is to explore the experiences of physicians and other clinicians assessing public long-term work disability related to mental disorders. METHODS: This is an exploratory and descriptive study using qualitative methods. Clinician input was gathered through focus groups and individual in-depth interviews. Verbatim transcripts were analyzed to identify recurrent and significant themes that arose during the focus groups and individual interviews. RESULTS: Many of the experiences that the clinicians in this sample discussed related to the difficulty of trying to fill the roles of advocate and medical expert as well as the challenge of determining the impact of functional capacity and work ability. The findings also highlight the current gap in knowledge about the factors that affect successful functioning in general and at work in particular. CONCLUSIONS: Given the challenges created by the current state of knowledge, it may be useful to consider a category of "partial disability". In addition, the fact that work disability depends on the interaction between the experience of the mental disorder and specific job requirements and the fact that people applying for public long-term disability are not working, it might be helpful to offer a clear description and guidelines of the meaning of work ability.

Background Over the past decade, growing attention has been given to the mental health of workers. One way to examine the mental health of workers is to look at the incidence rates of mental illness-related sickness absence. There is a scarcity of literature in which the incidence rates of mental illness-related sickness absence among different countries have been considered together. The purpose of this systematic literature review is to address the question: Are there similarities and differences in the incidence rates of mental disorder-related sickness absence among and within OECD identified Social Democratic, Liberal and Latin American country categories? In this paper, we seek to identify differences and similarities in the literature rather than to explain them. With this review, we lay the groundwork for and point to areas for future research as well as to raise questions regarding reasons for the differences and similarities. Methods A systematic literature search of the following databases were performed: Medline Current, Medline In-process, PsycINFO, Econlit and Web of Science. The search period covered 2002–2013. The systematic literature search focused on working adults between 18–65 years old who had not retired and who had mental and/or substance abuse disorders. Intervention studies were excluded. The search focused on medically certified sickness absences. Results A total of 3,818 unique citations were identified. Of these, 10 studies met the inclusion/exclusion criteria; six were from Social Democratic countries. Their quality ranged from good to excellent. There was variation in the incidence rates reported by the studies from the Social Democratic, Liberal and Latin American countries in this review. Conclusions The results of this systematic review suggest that this is an emerging area of inquiry that needs to continue to grow. Priority areas to support growth include cross jurisdictional collaboration and development of a typology characterizing the benefit generosity and work integration policies of sickness absence schemes. Finally, the literature should be updated to reflect changes in sickness absence benefit schemes over time.

BackgroundMajor depressive disorder (MDD) negatively affects a wide range of work outcomes (absenteeism, work productivity, work limitations). However, the exact longitudinal relationship between depressive symptoms and work outcomes in MDD patients with long-term sickness absence is still unclear. Therefore, the present study aimed to examine the temporal and directional relationship between depressive symptoms and various work outcomes in these patients.MethodsPatients (n=117) were diagnosed with MDD according to DSM-IV criteria, had a median duration of MDD-related sickness absence of 4.8 months (IQR=2.6–10.1 months) at baseline, and were referred by occupational physicians. All patients received outpatient treatment for their MDD. Depressive symptoms and work outcomes were examined during baseline, and 6-, 12- and 18-month follow-ups.ResultsWithin-subject changes in the severity of depressive symptoms were significantly related to within-subject changes in all work outcomes (all scales: p

Objectives To evaluate whether adjuvant occupational therapy (OT) can improve the effectiveness of treatment-as-usual (TAU) in sick-listed employees with major depression. Methods In total, 117 employees sick-listed for a median duration of 4.8 months (IQR=2.6 to 10.1 months) because of major depression were randomised to TAU (n=39) or adjuvant OT (TAU+OT; n=78). OT (18 sessions) focussed on a fast return to work (RTW) and improving work-related coping and self-efficacy. The primary outcome was work participation (hours of absenteeism+duration until partial/full RTW). Secondary outcomes were depression, at-work functioning, and health-related functioning. Intermediate outcomes were work-related, coping and self-efficacy. Blinded assessments occurred at baseline and 6, 12 and 18 months follow-up. Results The groups did not significantly differ in their overall work participation (adjusted group difference=−1.9, 95% CI −19.9 to +16.2). However, those in TAU+OT did show greater improvement in depression symptoms (−2.8, −5.5 to −0.2), an increased probability of long-term symptom remission (+18%, +7% to +30%), and increased probability of long-term RTW in good health (GH) (+24%, 12% to 36%). There were no significant group differences in the remaining secondary/intermediate outcomes. Conclusions In a highly impaired population, we could not demonstrate significant benefit of adjuvant OT for improving overall work participation. However, adjuvant OT did increase long-term depression recovery and long-term RTW in GH (ie, full RTW while being remitted, and with better work and role functioning). Trial Registration Dutch Trial Register NTR2057.

Objective Although major depressive disorder (MDD) has substantial negative effects on work outcomes, little is known regarding how to promote a return to work (RTW) after MDD-related sickness absence. The present study aimed to examine predictors across multiple domains for long-term RTW in patients who are sick-listed because of their MDD, and to compare these with predictors for long-term symptom remission. Method Participants (n = 117) were diagnosed with MDD according to DSM-IV criteria, absent from work for at least 25% of their contract hours, and referred by occupational physicians to outpatient treatment. Long-term full RTW (working the full number of contract hours for at least 4 weeks) and long-term symptom remission (Hamilton Depression Rating Scale score ≤ 7) were examined during the 18-month follow-up. Potential predictors (diagnostic, sociodemographic, personality, and work-related) were assessed at baseline. Data were collected from December 2007 to March 2011. Results Stepwise logistic regression analyses with backward elimination (P ≤ .05) resulted in a final prediction model including depression severity (odds ratio [OR] = 0.92; 95% CI, 0.87-0.97; P = .003), comorbid anxiety (OR = 0.21; 95% CI, 0.05-0.84; P = .028), work motivation (OR = 1.87; 95% CI, 1.18-2.96; P = .008), and conscientiousness (OR = 1.10; 95% CI, 1.02-1.18; P = .012) as predictors of long-term RTW. Long-term symptom remission was only predicted by depression severity (OR = 0.93; 95% CI, 0.89-0.98; P = .005). Conclusions Whereas long-term symptom remission is only predicted by diagnostic factors, long-term RTW is also predicted by personal and work-related factors. These findings provide suggestions for the development of new interventions to improve both symptom remission and long-term RTW in sick-listed patients with MDD.

Background Major depressive disorder is among the medical conditions with the highest negative impact on work outcome. However, little is known regarding evidence-based interventions targeting the improvement of work outcomes in depressed employees. In this paper, the design of a randomized controlled trial is presented in order to evaluate the effectiveness of adjuvant occupational therapy in employees with depression. This occupational intervention is based on an earlier intervention, which was designed and proven effective by our research group, and is the only intervention to date that specifically targets work outcome in depressed employees. Methods/Design In a two-arm randomized controlled trial, a total of 117 participants are randomized to either 'care as usual' or ' care as usual' with the addition of occupational therapy. Patients included in the study are employees who are absent from work due to depression for at least 25% of their contract hours, and who have a possibility of returning to their own or a new job. The occupational intervention consists of six individual sessions, eight group sessions and a work-place visit over a 16-week period. By increasing exposure to the working environment, and by stimulating communication between employer and employee, the occupational intervention aims to enhance self-efficacy and the acquisition of more adaptive coping strategies. Assessments take place at baseline, and at 6, 12, and 18-month follow-ups. Primary outcome measure is work participation (hours of absenteeism and time until work resumption). Secondary outcome measures are work functioning, symptomatology, health-related quality of life, and neurocognitive functioning. In addition, cost-effectiveness is evaluated from a societal perspective. Finally, mechanisms of change (intermediate outcomes) and potential patient-treatment matching variables are investigated. Discussion This study hopes to provide valuable knowledge regarding an intervention to treat depression, one of the most common and debilitating diseases of our time. If our intervention is proven (cost-) effective, the personal, economic, and health benefits for both patients and employers are far-reaching. Trial registration number NTR2057