Recovery from depression, work productivity, and health care costs among primary care patients.
ABSTRACT We describe a secondary analysis of data from a randomized trial conducted at seven primary care clinics of a Seattle area HMO. Adults with major depression (n=290) beginning antidepressant treatment completed structured interviews at baseline, 1, 3, 6, 9, 12, 18, and 24 months. Interviews examined clinical outcomes (Hamilton Depression Rating Scale and depression module of the Structured Clinical Interview for DSM-IIIR), employment status, and work days missed due to illness. Medical comorbidity was assessed using computerized pharmacy data, and medical costs were assessed using the HMO's computerized accounting data. Using data from the 12-month assessment, patients were classified as remitted (41%), improved but not remitted (47%), and persistently depressed (12%). After adjustment for depression severity and medical comorbidity at baseline, patients with greater clinical improvement were more likely to maintain paid employment (P=.007) and reported fewer days missed from work due to illness (P<.001). Patients with better 12-month clinical outcomes had marginally lower health care costs during the second year of follow-up (P=.06). We conclude that recovery from depression is associated with significant reductions in work disability and possible reductions in health care costs. Although observational data cannot definitively prove any causal relationships, these longitudinal results strengthen previous findings regarding the economic burden of depression on employers and health insurers.
SourceAvailable from: Fiona Cocker[Show abstract] [Hide abstract]
ABSTRACT: Working through a depressive illness can improve mental health but also carries risks and costs from reduced concentration, fatigue, and poor on-the-job performance. However, evidence-based recommendations for managing work attendance decisions, which benefit individuals and employers, are lacking. Therefore, this study has compared the costs and health outcomes of short-term absenteeism versus working while ill ("presenteeism") amongst employed Australians reporting lifetime major depression.PLoS ONE 09/2014; 9(9):e105430. DOI:10.1371/journal.pone.0105430 · 3.53 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Streszczenie Osoby z zaburzeniami psychicznymi stanowią w Polsce liczną grupę. W 2010 r. psychiatryczną opieką ambulatoryjną obję-tych było prawie 1,5 mln osób, natomiast w całodobowych oddziałach psychiatrycznych leczono około 200 tys. chorych. Jedy-nie 17% osób niepełnosprawnych psychicznie jest aktywnych zawodowo. Badania dowodzą, że mimo niekorzystnego wpływu zaburzeń psychicznych na zatrudnienie (np. obniżona produktywność, absentyzm, prezentyzm, zwiększone ryzyko wypad-ków w pracy), praca może mieć kluczowe znaczenie dla stabilizacji stanu psychicznego, a także może pomóc w powrocie do zdrowia. Osoby z zaburzeniami psychicznymi są grupą społeczną najbardziej narażoną na wykluczenie z rynku pracy. Wśród pracodawców przeważa opinia, że osoby chorujące psychicznie mają ograniczoną zdolność do pracy zawodowej, a społecz-ne postawy wobec nich cechuje tendencja do naznaczania i piętnowania. W artykule omówiono korzyści dla zdrowia wyni-kające z podjęcia pracy w przebiegu choroby psychicznej, bariery napotykane przez chorych w podejmowaniu i kontynuowa-niu pracy oraz zawodowe funkcjonowanie osób z rozpoznaną depresją (będącą przykładem zaburzeń afektywnych) i schizo-frenią (będącą przykładem zaburzeń psychotycznych). Analiza dostępnych danych wskazuje, że w celu polepszenia sytuacji osób chorujących psychicznie na rynku pracy konieczna jest ścisła współpraca przedstawicieli różnych specjalności medycz-nych i ich aktywne zaangażowanie w proces rehabilitacji społeczno-zawodowej osób dotkniętych zaburzeniami psychicznymi. Med. Pr. 2015;66(1) Słowa kluczowe: zaburzenia psychiczne, schizofrenia, depresja, zatrudnienie, aktywność zawodowa, powrót do pracy Abstract In Poland patients with psychiatric problems form a large group; in 2010 there were almost 1.5 million people for whom outpatient psychiatric care was provided, whereas approximately 200 thousand ill individuals were treated in 24-h psychiatric wards. Only 17% of the mentally disabled are professionally active. The results of many researches show that despite the detrimental influence of mental disorders on the employment (e.g., lower productivity, absenteeism, presenteism, increased risk of accidents at the workplace), professional activity can play a key role in the stabilization of the mental state, it can also help in disease recovery. People with mental disorders are a social group that is at the higher risk of exclusion from the job market. The opinion prevailing among employers is that mentally ill individuals have decreased ability to conduct professional activity , and social attitudes towards them tend to be based on marking and stigmatizing. This review tackles the advantages of working during the illness, barriers which people with mental disorders face on the job market when they want to either start or continue work, and professional functioning of people with diagnosed depression (e.g., affective disorders) and schizophre-nia (representing psychotic disorders). The analysis of existing data show that to improve the situation of mentally ill people present on the job market close cooperation between the representatives of various medical specializations is necessary, as well as their active participation in the process of social and professional rehabilitation of people affected by mental disorders. Med Pr 2015;66(1)Medycyna pracy 01/2015; 66(1). DOI:10.13075/mp.5893.00173 · 0.32 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Work disability such as sickness absence is common in people with depression. To evaluate the effectiveness of interventions aimed at reducing work disability in employees with depressive disorders. We searched CENTRAL (The Cochrane Library), MEDLINE, EMBASE, CINAHL, and PsycINFO until January 2014. We included randomised controlled trials (RCTs) and cluster RCTs of work-directed and clinical interventions for depressed people that included sickness absence as an outcome. Two authors independently extracted the data and assessed trial quality. We used standardised mean differences (SMDs) with 95% confidence intervals (CIs) to pool study results in the studies we judged to be sufficiently similar. We used GRADE to rate the quality of the evidence. We included 23 studies with 26 study arms, involving 5996 participants with either a major depressive disorder or a high level of depressive symptoms. We judged 14 studies to have a high risk of bias and nine to have a low risk of bias. Work-directed interventionsWe identified five work-directed interventions. There was moderate quality evidence that a work-directed intervention added to a clinical intervention reduced sickness absence (SMD -0.40; 95% CI -0.66 to -0.14; 3 studies) compared to a clinical intervention alone.There was moderate quality evidence based on a single study that enhancing the clinical care in addition to regular work-directed care was not more effective than work-directed care alone (SMD -0.14; 95% CI -0.49 to 0.21).There was very low quality evidence based on one study that regular care by occupational physicians that was enhanced with an exposure-based return to work program did not reduce sickness absence compared to regular care by occupational physicians (non-significant finding: SMD 0.45; 95% CI -0.00 to 0.91). Clinical interventions, antidepressant medicationThree studies compared the effectiveness of selective serotonin reuptake inhibitor (SSRI) to selective norepinephrine reuptake inhibitor (SNRI) medication on reducing sickness absence and yielded highly inconsistent results. Clinical interventions, psychological We found moderate quality evidence based on three studies that telephone or online cognitive behavioural therapy was more effective in reducing sick leave than usual primary or occupational care (SMD -0.23; 95% CI -0.45 to -0.01). Clinical interventions, psychological combined with antidepressant medicationWe found low quality evidence based on two studies that enhanced primary care did not substantially decrease sickness absence in the medium term (4 to 12 months) (SMD -0.02; 95% CI -0.15 to 0.12). A third study found no substantial effect on sickness absence in favour of this intervention in the long term (24 months).We found high quality evidence, based on one study, that a structured telephone outreach and care management program was more effective in reducing sickness absence than usual care (SMD - 0.21; 95% CI -0.37 to -0.05). Clinical interventions, exerciseWe found low quality evidence based on one study that supervised strength exercise reduced sickness absence compared to relaxation (SMD -1.11; 95% CI -1.68 to -0.54). We found moderate quality evidence based on two studies that aerobic exercise was no more effective in reducing sickness absence than relaxation or stretching (SMD -0.06; 95% CI -0.36 to 0.24). We found moderate quality evidence that adding a work-directed intervention to a clinical intervention reduced the number of days on sick leave compared to a clinical intervention alone. We also found moderate quality evidence that enhancing primary or occupational care with cognitive behavioural therapy reduced sick leave compared to the usual care. A structured telephone outreach and care management program that included medication reduced sickness absence compared to usual care. However, enhancing primary care with a quality improvement program did not have a considerable effect on sickness absence. There was no evidence of a difference in effect on sickness absence of one antidepressant medication compared to another. More studies are needed on work-directed interventions. Clinical intervention studies should also include work outcomes to increase our knowledge on reducing sickness absence in depressed workers.Cochrane database of systematic reviews (Online) 12/2014; 12(12):CD006237. DOI:10.1002/14651858.CD006237.pub3 · 5.70 Impact Factor