Interventions to improve occupational health in depressed people

  • Review
  • Intervention

Authors

  • Karen Nieuwenhuijsen,

    Corresponding author
    1. Academic Medical Centre, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam, Netherlands
    • Karen Nieuwenhuijsen, Coronel Institute of Occupational Health, Academic Medical Centre, University of Amsterdam, PO Box 22700, Amsterdam, 1100 DE , Netherlands. K.Nieuwenhuijsen@amc.uva.nl.

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  • Ute Bültmann,

    1. National Institute of Occupational Health, Copenhagen, Denmark
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  • Angela Neumeyer-Gromen,

    1. Federal Institute for Occupational Safety and Health, Unit "Epidemiology, Risk Assessment", Berlin, Germany
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  • Arco C Verhoeven,

    1. Academic Medical Centre, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam, Netherlands
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  • Jos H Verbeek,

    1. Cochrane Occupational Health Field, Finnish Institute of Occupational Health, Center of Expertise for Good Practices and Competence, Team of Knowledge Transfer in Occupational Health and Safety, Kuopio, Finland
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  • Christina M. Feltz-Cornelis

    1. Trimbos-Instituut / Netherlands institute of Mental Health and Addiction, Utrecht, Netherlands
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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 depressed workers.

Search methods

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..

摘要

背景

改善憂鬱患者職業健康的處置

對於憂鬱症的患者來說,生病缺席等工作上的失能是常見的現象

目標

評估心理處置的效果,而這些心理處置是用來降低憂鬱症患者的工作失能

搜尋策略

我們搜尋到2/8/2006的the CCDANCTRStudies and CCDANCTRReferences 。Cochrane Library CENTRAL register, MEDLINE, EMBASE, CINAHL, PsycINFO, OSHROM (Occupational Safety and Health), NHSEED, and DARE.

選擇標準

我們採用了所有針對憂鬱症患者的研究,以工作導向和以工作者導向的隨機控制試驗和集束隨機對照試驗,並使用因生病缺席來當作主要結果。

資料收集與分析

由兩位作者各自的摘錄資料和評估研究的品質。我們使用標準平均數差異(SMD)和95%的信賴區間來整合資料。

主要結論

我們採用11篇研究,全都是以工作者為導向的心理處置,共有2556名受試。只有一篇研究是強調工作議題,以adjuvant occupational therapy來稱呼。其他處置是評估抗鬱劑(selective serotonin reuptake inhibitors, serotoninnorepinephrine reuptake inhibitors, tricyclic antidepressants, monoaminooxidase inhibitors),心理動力論和強化自我照顧及心理處置。在藥物上,整合3篇研究的結果(n = 864)發現抗鬱劑和其他種的藥物對於白天是否因為生病缺席並沒有明顯差異 (SMD 0.09; 95% CI −0.05 to 0.23)。在兩個整合的研究中(n = 969),針對生病缺席的強化照護和一般的照護狀況並沒有呈現顯著差異(SMD −0.02; 95% CI −0.15 to 0.12)。其他的比較都是針對單項研究 (n = 6), 發現在不同組別間因生病缺席的狀況並沒有顯著差異。只有在一個研究中,結合心理動力治療和TCAs治療,和單純的TCAs治療組中,結合治療組較好些。

作者結論

由於研究樣本的異質性,對於單純只使用藥物的效果、只使用強化自我照顧的效果、只使用心理處置的效果或者是藥物結合這些治療方式的效果而言目前都沒有證據支持。在未來RCTs,治療處置可能特別針對工作相關議題,而職能的結果應該用來測量效果。

翻譯人

本摘要由彰化基督教醫院胡淑惠翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

改善憂鬱患者職業健康的處置。在憂鬱症患者身上經常出現了一些工作失能的狀況,譬如生病缺席、未達到理想工作職能。然而,我們並不知道如何有效的增進這一群人的工作能力。這一篇文獻的目的是評估在憂鬱症的患者身上,以工作為導向或者以工作人員為導向的心理處置在降低工作失能的效果如何。我們發現有11篇研究,包含2556名受試。這11篇都是以工作人員為導向的心理處置。其中,只有一篇研究在治療過程有特別提到工作方面的議題,但是它並沒有說明處置的效果。其他的處置中,有關抗鬱劑治療(4篇),心理動力論治療(1篇),電腦認知行為治療(1篇),問題解決治療(1篇),強化自我照顧(3篇)。只有一篇是結合三還抗鬱劑和心理動力治療,其他的研究並沒有提供任何長短期的治療結果。我們發現單純使用藥物或者強化自我照顧治療並沒有辦法降低憂鬱症患者工作失能的狀況。此外也發現沒有證據支持或反對任何心理處置能降低憂鬱症患者的工作失能狀況。

Plain language summary

Interventions to improve occupational health in depressed people

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.

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