title: Telephone cognitive-behavioral therapy for subthreshold depression and presenteeism in workplace: a randomized controlled trial.
abstract: BACKGROUND
  Subthreshold depression is highly prevalent in the general population and causes great loss to society especially in the form of reduced productivity while at work (presenteeism). We developed a highly-structured manualized eight-session cognitive-behavioral program with a focus on subthreshold depression in the workplace and to be administered via telephone by trained psychotherapists (tCBT).
  
  
  METHODS
  We conducted a parallel-group, non-blinded randomized controlled trial of tCBT in addition to the pre-existing Employee Assistance Program (EAP) versus EAP alone among workers with subthreshold depression at a large manufacturing company in Japan. The primary outcomes were depression severity as measured with Beck Depression Inventory-II (BDI-II) and presenteeism as measured with World Health Organization Health and Work Productivity Questionnaire (HPQ). In the course of the trial the follow-up period was shortened in order to increase acceptability of the study.
  
  
  RESULTS
  The planned sample size was 108 per arm but the trial was stopped early due to low accrual. Altogether 118 subjects were randomized to tCBT+EAP (n = 58) and to EAP alone (n = 60). The BDI-II scores fell from the mean of 17.3 at baseline to 11.0 in the intervention group and to 15.7 in the control group after 4 months (p<0.001, Effect size = 0.69, 95%CI: 0.32 to 1.05). However, there was no statistically significant decrease in absolute and relative presenteeism (p = 0.44, ES = 0.15, -0.21 to 0.52, and p = 0.50, ES = 0.02, -0.34 to 0.39, respectively).
  
  
  CONCLUSIONS
  Remote CBT, including tCBT, may provide easy access to quality-assured effective psychotherapy for people in the work force who present with subthreshold depression. Further studies are needed to evaluate the effectiveness of this approach in longer terms. The study was funded by Sekisui Chemicals Co. Ltd.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00885014.
authors.affiliation: Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. furukawa@kuhp.kyoto-u.ac.jp
authors.forename: Toshi A
authors.initials: TA
authors.lastname: Furukawa
authors.forename: Masaru
authors.initials: M
authors.lastname: Horikoshi
authors.forename: Norito
authors.initials: N
authors.lastname: Kawakami
authors.forename: Masayo
authors.initials: M
authors.lastname: Kadota
authors.forename: Megumi
authors.initials: M
authors.lastname: Sasaki
authors.forename: Yuki
authors.initials: Y
authors.lastname: Sekiya
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hosogoshi
authors.forename: Masami
authors.initials: M
authors.lastname: Kashimura
authors.forename: Kenichi
authors.initials: K
authors.lastname: Asano
authors.forename: Hitomi
authors.initials: H
authors.lastname: Terashima
authors.forename: Kazunori
authors.initials: K
authors.lastname: Iwasa
authors.forename: Minoru
authors.initials: M
authors.lastname: Nagasaku
authors.forename: Louis C
authors.initials: LC
authors.lastname: Grothaus
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000523:psychology / Q000628:therapy*; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D004526:Efficiency; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D019114:Remote Consultation / Q000379:methods*; D012720:Severity of Illness Index; D013689:Telephone; D016896:Treatment Outcome; D017132:Workplace / Q000523:psychology*