Interventions to improve occupational health in depressed people.
BACKGROUND
Work disability such as sickness absence is common in people with depression.


OBJECTIVE
To evaluate the effectiveness of interventions aimed at reducing work disability in depressed workers.


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.


METHODS
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


METHODS
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.


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.


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..
Nieuwenhuijsen
K
K
Academic Medical Centre, Univeriteit van Amsterdam, Coronel Institute of Occupational Health, PO Box 22700, Amsterdam, Netherlands, 1100 DE. K.Nieuwenhuijsen@amc.uva.nl
Bültmann
U
U
Neumeyer-Gromen
A
A
Verhoeven
A C
AC
Verbeek
J H A M
JH
van der Feltz-Cornelis
C M
CM
D000041:Absenteeism; D003863:Depression / Q000628:therapy*; D006801:Humans; D016272:Occupational Health; D016032:Randomized Controlled Trials as Topic