Managing depression-related occupational disability: a pragmatic approach.
OBJECTIVE
To identify the crucial issues that arise for psychiatrists and other physicians when dealing with occupational disability in their patients with depression and to suggest practical strategies for responding more effectively to the challenges of this aspect of patient functioning.


METHODS
We identify fundamental concepts in the occupational disability domain and draw crucial distinctions. The wider context for occupational disability is articulated, involving the workplace environment and the disability insurance industry. Research with direct relevance to clinical decision making in this area is highlighted. We make pragmatic suggestions for effective management of occupational disability in patients with depression.


RESULTS
To successfully manage issues of occupational disability, psychiatrists and other physicians must understand the distinction between impairment and disability. To make this decision fairly and accurately, the adjudicator requires particular types of information from the physician, with requirements varying across short-term or long-term disability claims; failing to provide relevant information may cause substantial stress or financial harm to the patient. Balanced and collaborative decision making regarding whether and for how long to take work absence will greatly help to maintain occupational function in the long-term. Realistic expectations and support of the patient's sense of personal competence foster recovery of occupational function.


CONCLUSIONS
Management of depression-related disability is challenging. Thoughtful evaluation of the patient's functional status, careful response to the requirements of disability determination, and a focus on functional recovery yield substantial benefits.
Bilsker
Dan
D
Psychiatric Assessment Unit, Vancouver General Hospital, British Columbia. Dan.Bilsker@vch.ca
Wiseman
Stephen
S
Gilbert
Merv
M
D002170:Canada; D019090:Case Management; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D006233:Persons with Disabilities / Q000523:psychology* / Q000706:statistics & numerical data*; D004651:Employment / Q000331:legislation & jurisprudence; D006801:Humans; D007348:Insurance, Health; D009784:Occupational Diseases / Q000191:economics / Q000523:psychology* / Q000628:therapy; D018582:Sick Leave / Q000706:statistics & numerical data; D017132:Workplace / Q000523:psychology*