Interventions to improve return to work in depressed people

K. Nieuwenhuijsen, B. Faber, J. Verbeek, A. Neumeyer-Gromen , H.L. Hees, A.C. Verhoeven, C.M. van der Feltz-Cornelis, U. Bültmann

Research output: Contribution to journalReview articleScientificpeer-review

Abstract

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 January 2014.
Selection criteria
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.
Data collection and analysis
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.
Main results
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 interventions
We 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 medication
Three 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 medication
We 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, exercise
We 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).
Authors' conclusions
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.
Original languageEnglish
Article numberCD006237
JournalCochrane Database of Systematic Reviews
Volume12
DOIs
Publication statusPublished - 2014

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Nieuwenhuijsen, K., Faber, B., Verbeek, J., Neumeyer-Gromen , A., Hees, H. L., Verhoeven, A. C., ... Bültmann, U. (2014). Interventions to improve return to work in depressed people. Cochrane Database of Systematic Reviews, 12, [CD006237]. https://doi.org/10.1002/14651858.CD006237.pub3
Nieuwenhuijsen, K. ; Faber, B. ; Verbeek, J. ; Neumeyer-Gromen , A. ; Hees, H.L. ; Verhoeven, A.C. ; van der Feltz-Cornelis, C.M. ; Bültmann, U. / Interventions to improve return to work in depressed people. In: Cochrane Database of Systematic Reviews. 2014 ; Vol. 12.
@article{42a9d575e5c942c68b0dbd1436d857f1,
title = "Interventions to improve return to work in depressed people",
abstract = "BackgroundWork disability such as sickness absence is common in people with depression.ObjectivesTo evaluate the effectiveness of interventions aimed at reducing work disability in employees with depressive disorders.Search methodsWe searched CENTRAL (The Cochrane Library), MEDLINE, EMBASE, CINAHL, and PsycINFO until January 2014.Selection criteriaWe included randomised controlled trials (RCTs) and cluster RCTs of work-directed and clinical interventions for depressed people that included sickness absence as an outcome.Data collection and analysisTwo 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.Main resultsWe 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, psychologicalWe 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).Authors' conclusionsWe 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.",
author = "K. Nieuwenhuijsen and B. Faber and J. Verbeek and A. Neumeyer-Gromen and H.L. Hees and A.C. Verhoeven and {van der Feltz-Cornelis}, C.M. and U. B{\"u}ltmann",
year = "2014",
doi = "10.1002/14651858.CD006237.pub3",
language = "English",
volume = "12",
journal = "Cochrane Database of Systematic Reviews",
issn = "1469-493X",
publisher = "John Wiley and Sons Ltd",

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Nieuwenhuijsen, K, Faber, B, Verbeek, J, Neumeyer-Gromen , A, Hees, HL, Verhoeven, AC, van der Feltz-Cornelis, CM & Bültmann, U 2014, 'Interventions to improve return to work in depressed people', Cochrane Database of Systematic Reviews, vol. 12, CD006237. https://doi.org/10.1002/14651858.CD006237.pub3

Interventions to improve return to work in depressed people. / Nieuwenhuijsen, K.; Faber, B.; Verbeek, J.; Neumeyer-Gromen , A.; Hees, H.L.; Verhoeven, A.C.; van der Feltz-Cornelis, C.M.; Bültmann, U.

In: Cochrane Database of Systematic Reviews, Vol. 12, CD006237, 2014.

Research output: Contribution to journalReview articleScientificpeer-review

TY - JOUR

T1 - Interventions to improve return to work in depressed people

AU - Nieuwenhuijsen, K.

AU - Faber, B.

AU - Verbeek, J.

AU - Neumeyer-Gromen , A.

AU - Hees, H.L.

AU - Verhoeven, A.C.

AU - van der Feltz-Cornelis, C.M.

AU - Bültmann, U.

PY - 2014

Y1 - 2014

N2 - BackgroundWork disability such as sickness absence is common in people with depression.ObjectivesTo evaluate the effectiveness of interventions aimed at reducing work disability in employees with depressive disorders.Search methodsWe searched CENTRAL (The Cochrane Library), MEDLINE, EMBASE, CINAHL, and PsycINFO until January 2014.Selection criteriaWe included randomised controlled trials (RCTs) and cluster RCTs of work-directed and clinical interventions for depressed people that included sickness absence as an outcome.Data collection and analysisTwo 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.Main resultsWe 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, psychologicalWe 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).Authors' conclusionsWe 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.

AB - BackgroundWork disability such as sickness absence is common in people with depression.ObjectivesTo evaluate the effectiveness of interventions aimed at reducing work disability in employees with depressive disorders.Search methodsWe searched CENTRAL (The Cochrane Library), MEDLINE, EMBASE, CINAHL, and PsycINFO until January 2014.Selection criteriaWe included randomised controlled trials (RCTs) and cluster RCTs of work-directed and clinical interventions for depressed people that included sickness absence as an outcome.Data collection and analysisTwo 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.Main resultsWe 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, psychologicalWe 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).Authors' conclusionsWe 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.

U2 - 10.1002/14651858.CD006237.pub3

DO - 10.1002/14651858.CD006237.pub3

M3 - Review article

VL - 12

JO - Cochrane Database of Systematic Reviews

JF - Cochrane Database of Systematic Reviews

SN - 1469-493X

M1 - CD006237

ER -

Nieuwenhuijsen K, Faber B, Verbeek J, Neumeyer-Gromen A, Hees HL, Verhoeven AC et al. Interventions to improve return to work in depressed people. Cochrane Database of Systematic Reviews. 2014;12. CD006237. https://doi.org/10.1002/14651858.CD006237.pub3