title: Adjuvant occupational therapy for work-related major depression works: randomized trial including economic evaluation.
abstract: BACKGROUND
  Major depression has far-reaching consequences for work functioning and absenteeism. In most cases depression is treated by medication and clinical management. The addition of occupational therapy (OT) might improve outcome. We determined the cost-effectiveness of the addition of OT to treatment as usual (TAU).
  
  
  METHODS
  Sixty-two adults with major depression and a mean absenteeism of 242 days were randomized to TAU (out-patient psychiatric treatment) or TAU+OT [6 months, including (i) diagnostic phase with occupational history and work reintegration plan, and (ii) therapeutic phase with individual sessions and group sessions]. Main outcome domains were depression, work resumption, work stress and costs. Assessments were at baseline and at 3, 6, 12 and 42 months.
  
  
  RESULTS
  The addition of OT to TAU: (i) did not improve depression outcome, (ii) resulted in a reduction in work-loss days during the first 18 months, (iii) did not increase work stress, and (iv) had a 75.5% probability of being more cost-effective than TAU alone.
  
  
  CONCLUSIONS
  Addition of OT to good clinical practice does not improve depression outcome, improves productivity without increasing work stress and is superior to TAU in terms of cost-effectiveness.
authors.affiliation: Department of Psychiatry, Programme for Mood Disorders, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. a.h.schene@amc.uva.nl
authors.forename: Aart H
authors.initials: AH
authors.lastname: Schene
authors.forename: Maarten W J
authors.initials: MW
authors.lastname: Koeter
authors.forename: Martijn J
authors.initials: MJ
authors.lastname: Kikkert
authors.forename: Jan A
authors.initials: JA
authors.lastname: Swinkels
authors.forename: Paul
authors.initials: P
authors.lastname: McCrone
mesh_terms: D000041:Absenteeism; D000328:Adult; D000928:Antidepressive Agents / Q000191:economics / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy / Q000191:economics; D003131:Combined Modality Therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D003865:Major Depressive Disorder / Q000191:economics / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009784:Occupational Diseases / Q000191:economics / Q000534:rehabilitation*; D009788:Occupational Therapy / Q000191:economics*; D011615:Psychotherapy, Group / Q000191:economics; D012050:Rehabilitation, Vocational / Q000191:economics*; D013315:Stress, Psychological / Q000150:complications
chemical_list: D000928:Antidepressive Agents