Interventions to improve return to work in depressed people

Area of Science:

• Occupational Health
• Psychiatry
• Evidence-Based Medicine

Background:

• Work disability, including sickness absence, is a prevalent issue for individuals experiencing depression.
• Depressive disorders significantly impact an employee's ability to maintain regular work attendance.

Purpose of the Study:

• To systematically evaluate the efficacy of interventions designed to decrease work disability in employees diagnosed with depressive disorders.
• To synthesize evidence from randomized controlled trials (RCTs) on interventions targeting sickness absence in depressed workers.

Main Methods:

• A comprehensive literature search was conducted across multiple databases (CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO) up to January 2014.
• Included studies were randomized controlled trials (RCTs) and cluster RCTs assessing work-directed and clinical interventions with sickness absence as a primary outcome.
• Data extraction and quality assessment were performed independently by two authors, with meta-analysis using standardized mean differences (SMDs) and GRADE for evidence rating.

Main Results:

• Moderate quality evidence indicates that combining work-directed interventions with clinical interventions reduces sickness absence compared to clinical interventions alone (SMD -0.40; 95% CI -0.66 to -0.14).
• Telephone or online cognitive behavioral therapy demonstrated moderate quality evidence for reducing sick leave compared to usual care (SMD -0.23; 95% CI -0.45 to -0.01).
• A structured telephone outreach and care management program, including medication, showed high-quality evidence of reducing sickness absence (SMD -0.21; 95% CI -0.37 to -0.05).

Conclusions:

• Adding work-directed interventions to clinical treatments is effective in reducing sick leave days for depressed employees.
• Cognitive behavioral therapy delivered via telephone or online platforms offers a significant benefit in reducing sick leave.
• Further research is recommended to explore work-directed interventions and include work-related outcomes in clinical intervention studies to better understand sickness absence reduction.