Interventions to improve occupational health in depressed people

Nieuwenhuijsen K, Bültmann U, Neumeyer-Gromen A, Verhoeven AC, Verbeek JH, Feltz-Cornelis CM.

Published Online:

January 21, 2009

Work disability such as sickness absence or suboptimal work functioning is common in people with depression. However, we do not know how to effectively improve work ability in this group. The objective of this review is to evaluate the effectiveness of work- and worker-directed interventions in reducing work disability of depressed workers. We found eleven studies, involving 2556 participants. None of the studies was work-directed. Of the worker-directed studies, only one study specifically addressed work issues during treatment but that study did not show an effect of the intervention. The other interventions studied were antidepressant medication (4 studies), psychodynamic therapy (1 study), computerised cognitive behavioural intervention (1 study), problem-solving therapy (1 study), and enhanced primary care (3 studies). One study found an effect of tricyclic antidepressant medication combined with psychodynamic therapy but none of the other studies did neither with short term nor with long term follow-up. We conclude that there is no evidence that medication alone or enhanced primary care reduces work disability in depressed workers. In addition, there is no evidence for or against the effectiveness of psychological interventions in reducing work disability of depressed workers.

Abstract (click to read)

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 depressed workers.

Search strategy:

We searched the CCDANCTR-Studies and CCDANCTR-References on 2/8/2006, Cochrane Library CENTRAL register, MEDLINE, EMBASE, CINAHL, PsycINFO, OSH-ROM (Occupational Safety and Health), NHS-EED, and DARE.

Selection criteria:

We included randomised controlled trials (RCTs) and cluster RCTs of work-directed and worker-directed interventions for depressed people, using sickness absence as the primary outcome

Data collection and analysis:

Two authors independently extracted data and assessed trial quality. We used standardised mean differences (SMD) with 95% confidence intervals (CIs) to pool study results where possible.

Main results:

We included eleven studies, all of worker-directed interventions, involving 2556 participants. Only one study addressed work issues using adjuvant occupational therapy. Other interventions evaluated anti-depressant medication (selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, monoamino-oxidase inhibitors), psychodynamic therapy, enhanced primary care and psychological treatment

For medication, the combined results of three studies (n=864) showed no difference between antidepressant medication and alternative medication in their effect on days of sickness absence (SMD 0.09; 95% CI -0.05 to 0.23) In two pooled studies (n=969), the effect of enhanced primary care on days of sickness absence did not differ from usual care in the medium term (SMD -0.02; 95% CI -0.15 to 0.12)

All other comparisons were based on single studies (n=6), all of which showed a lack of significant difference for sickness absence between groups, with the exception of one small study, combined psychodynamic therapy and TCAs versus TCAs alone, which favoured the combined treatment.

Authors' conclusions:

Based on a heterogeneous sample of studies, there is currently no evidence of an effect of medication alone, enhanced primary care, psychological interventions or the combination of those with medication on sickness absence of depressed workers. In future RCTs, interventions should specifically address work issues, and occupational outcomes should be used to measure the effect..

This record should be cited as:

Nieuwenhuijsen K, Bültmann U, Neumeyer-Gromen A, Verhoeven AC, Verbeek JH, Feltz-Cornelis CM.. Interventions to improve occupational health in depressed people. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD006237. DOI: 10.1002/14651858.CD006237.pub2

Assessed as up to date:

November 20, 2007

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Primary Review Group:

Depression, Anxiety and Neurosis Group

Health topics:

Mental health > Depression > Depressive disorders & major depression

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Interventions to improve occupational health in depressed people

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