title: Improving work outcomes of dysthymia (persistent depressive disorder) in an employed population.
abstract: OBJECTIVE
  To test the effectiveness of a work-focused intervention (WFI) on the work outcomes of employed adults with dysthymia.
  
  
  METHODS
  This subgroup analysis from a randomized controlled trial compares an initial sample of 167 employees (age: ≥45 years), screened for dysthymia using the PC-SAD without current major depressive disorder randomized to WFI (n=85) or usual care (UC) (n=82). Study sites included 19 employers and five additional organizations. Telephone-based WFI counseling (eight, twice monthly 50-min sessions) provided work coaching and modification, care coordination and cognitive behavioral therapy. Adjusted mixed effects models compared the WFI vs. UC group preintervention to 4-month postintervention change in at-work limitations measured by the Work Limitations Questionnaire. Secondary outcome analysis compared the change in self-reported absences and depression symptom severity (Patient Health Questionnaire PHQ-9 scores).
  
  
  RESULTS
  Work productivity loss scores improved 43.0% in the WFI group vs. 4.8% in UC (difference in change: P<.001). Absence days declined by 58.3% in WFI vs. 0.0% in UC (difference in change: P=.09). Mean PHQ-9 depression symptom severity declined 44.2% in WFI vs. 5.3% in UC (difference in change: P<.001).
  
  
  CONCLUSIONS
  At 4 months, the WFI was more effective than UC on two of the three outcomes. It could be an important mental and functional health improvement resource for the employed dysthymic population.
authors.affiliation: Program on Health, Work, and Productivity, Tufts Medical Center, 800 Washington Street, #345, Boston, MA 02111, USA; Tufts University School of Medicine, 145 Harrison Avenue, Boston, MA 02111, USA; Department of Psychiatry, Tufts Medical Center, 800 Washington Street, #345, Boston, MA 02111, USA. Electronic address: dadler@tuftsmedicalcenter.org.
authors.forename: David A
authors.initials: DA
authors.lastname: Adler
authors.affiliation: Program on Health, Work, and Productivity, Tufts Medical Center, 800 Washington Street, #345, Boston, MA 02111, USA; Tufts University School of Medicine, 145 Harrison Avenue, Boston, MA 02111, USA; Department of Psychiatry, Tufts Medical Center, 800 Washington Street, #345, Boston, MA 02111, USA. Electronic address: dlerner@tuftsmedicalcenter.org.
authors.forename: Debra
authors.initials: D
authors.lastname: Lerner
authors.affiliation: Program on Health, Work, and Productivity, Tufts Medical Center, 800 Washington Street, #345, Boston, MA 02111, USA. Electronic address: zvisco@tuftsmedicalcenter.org.
authors.forename: Zachary L
authors.initials: ZL
authors.lastname: Visco
authors.affiliation: Program on Health, Work, and Productivity, Tufts Medical Center, 800 Washington Street, #345, Boston, MA 02111, USA. Electronic address: agreenhill@tuftsmedicalcenter.org.
authors.forename: Annabel
authors.initials: A
authors.lastname: Greenhill
authors.affiliation: Program on Health, Work, and Productivity, Tufts Medical Center, 800 Washington Street, #345, Boston, MA 02111, USA. Electronic address: hchang@tuftsmedicalcenter.org.
authors.forename: Hong
authors.initials: H
authors.lastname: Chang
authors.affiliation: Department of Psychiatry, Tufts Medical Center, 800 Washington Street, #345, Boston, MA 02111, USA. Electronic address: ecymerman@tuftsmedicalcenter.org.
authors.forename: Elina
authors.initials: E
authors.lastname: Cymerman
authors.affiliation: OptumHealth, 425 Market Street, 14th Floor San Francisco, CA 94105, USA. Electronic address: francisca.azocar@optum.com.
authors.forename: Francisca
authors.initials: F
authors.lastname: Azocar
authors.affiliation: Program on Health, Work, and Productivity, Tufts Medical Center, 800 Washington Street, #345, Boston, MA 02111, USA. Electronic address: whrogers@tuftsmedicalcenter.org.
authors.forename: William H
authors.initials: WH
authors.lastname: Rogers
mesh_terms: D000041:Absenteeism; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D019263:Dysthymic Disorder / Q000628:therapy*; D004526:Efficiency; D004651:Employment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016272:Occupational Health; D018582:Sick Leave; D013689:Telephone; D016896:Treatment Outcome
keywords: Dysthymia; Economic issues; Mood disorder; Outcome studies; Work productivity