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

• Published in: Occupational and environmental medicine (London, England) Vol. 70; no. 4; pp. 252 - 260
• Main Authors: Hees, Hiske L, de Vries, Gabe, Koeter, Maarten W J, Schene, Aart H
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01-04-2013; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Absenteeism; Adaptation, Psychological; Adult; Depression - therapy; Depressive Disorder, Major - therapy; Depressive disorders; Disabilities; Disease remission; Employees; Female; Follow-Up Studies; Health; Humans; Intervention; Major depressive disorder; Male; Mental depression; Mental health; Mental health outcomes; Middle Aged; Occupational health; Occupational medicine; Occupational Therapy; Program Evaluation; Psychiatrists; Psychosis; Questionnaires; Remission (Medicine); Remission Induction; Return to Work; Self Efficacy; Sick Leave; Symptoms; Treatment Outcome; Workplace
• ISSN: 1351-0711; 1470-7926
• DOI: 10.1136/oemed-2012-100789

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.