title: Predictors of long-term return to work and symptom remission in sick-listed patients with major depression.
abstract: OBJECTIVE
  Although major depressive disorder (MDD) has substantial negative effects on work outcomes, little is known regarding how to promote a return to work (RTW) after MDD-related sickness absence. The present study aimed to examine predictors across multiple domains for long-term RTW in patients who are sick-listed because of their MDD, and to compare these with predictors for long-term symptom remission.
  
  
  METHODS
  Participants (n = 117) were diagnosed with MDD according to DSM-IV criteria, absent from work for at least 25% of their contract hours, and referred by occupational physicians to outpatient treatment. Long-term full RTW (working the full number of contract hours for at least 4 weeks) and long-term symptom remission (Hamilton Depression Rating Scale score ≤ 7) were examined during the 18-month follow-up. Potential predictors (diagnostic, sociodemographic, personality, and work-related) were assessed at baseline. Data were collected from December 2007 to March 2011.
  
  
  RESULTS
  Stepwise logistic regression analyses with backward elimination (P ≤ .05) resulted in a final prediction model including depression severity (odds ratio [OR] = 0.92; 95% CI, 0.87-0.97; P = .003), comorbid anxiety (OR = 0.21; 95% CI, 0.05-0.84; P = .028), work motivation (OR = 1.87; 95% CI, 1.18-2.96; P = .008), and conscientiousness (OR = 1.10; 95% CI, 1.02-1.18; P = .012) as predictors of long-term RTW. Long-term symptom remission was only predicted by depression severity (OR = 0.93; 95% CI, 0.89-0.98; P = .005).
  
  
  CONCLUSIONS
  Whereas long-term symptom remission is only predicted by diagnostic factors, long-term RTW is also predicted by personal and work-related factors. These findings provide suggestions for the development of new interventions to improve both symptom remission and long-term RTW in sick-listed patients with MDD.
authors.affiliation: Academic Medical Center, University of Amsterdam, Department of Psychiatry, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands. H.L.Hees@amc.uva.nl
authors.forename: Hiske L
authors.initials: HL
authors.lastname: Hees
authors.forename: Maarten W J
authors.initials: MW
authors.lastname: Koeter
authors.forename: Aart H
authors.initials: AH
authors.lastname: Schene
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009788:Occupational Therapy; D010555:Personality Inventory / Q000706:statistics & numerical data; D011594:Psychometrics; D012050:Rehabilitation, Vocational; D018582:Sick Leave