Sustainable return to work after depression – a comparative study among occupational physicians and affected employees Introduction: The number of sick days taken from work due to depression is steadily rising. A successful return to work (WE) is essential for sustainable reintegration. This study aims to identify factors to optimise WE and to investigate approaches for a sustainable WE after a depressive episode. Methods: Semi-structured expert interviews with senior occupational physicians (BÄ, n = 5) served to develop two surveys among BÄ (n = 180) and employees after a depressive episode (n = 192). Predictors of WE rating, workplace-based WE interventions and sustainable WE interventions were analysed using multiple hierarchical regression, chi-square difference and t-tests. Results: For BÄ, employee training on mental illness prevention was found to be the strongest predictor of overall WE rating, whereas understanding and appreciation in conversations and stigmatisation were the strongest predictors of overall WE rating by the employees. Compared to the employees, BÄ reported significantly more availability of workplace-based interventions. To prevent relapse, the employees prioritised sufficient time and financial security during the WE process more than BÄ. Conclusions: The study identified facilitating and hindering factors that can inform further research and practice to improve WE after depressive episodes. To redress the awareness gap about the availability of workplacebased interventions, regular contact between BÄ and employees is crucial. Several factors were considered to be of varying importance for relapse prevention by the two groups. Multiple perceptions and needs ought to be taken into account when planning the WE. Keywords: depression – return to work – sick leave – workplace – occupational medicine

A longitudinal study on the causal relationship between study-related stress, depressive symptoms and cognitive neuroenhancement among medical students in NRW Objectives: Medical students report high levels of study-related stress. They are also subject to an increased risk of depression. Study-related stress may lead to the consumption of a range of different substances in order to meet study requirements (pharmacological neuroenhancement = PN). This study therefore investigates the causal links between study-related stress, depression and PN. Methods: In total, 204 medical students in NRW (North Rhine-Westphalia) participated in the online survey [age: M(SD) = 24.1 (3.6); 20.1% male]. A longitudinal design with two measuring points was used with a 4-week interval. In order to measure PN, we asked how often different substances were consumed in the last four weeks to improve performance or reduce stress. The substances in question were divided and weighted according to soft enhancers, prescription drugs and illegal substances. Depressive symptoms were measured with the PHQ9 and study-related stress with the “Higher Education Stress Inventory”. Cross-lagged regression analysis (CLA) was used in order to determine causality. Results: The prevalence rates of depression were very high at 22.5% (t1) and 15.4% (t2). With regard to the causal relationship, study-related stress is a predictor of depressive symptoms but depression is not a predictor of study-related stress. Study-related stress is also a predictor of PN, but PN is not a predictor of stress. Both CLA effects were equally significant for depressive symptoms and PN. Conclusions: Study-related stress is a predictor of depressive symptoms and performance-enhancing PN. No clear causality could be found for depressive symptoms and PN, as they influence each other. Lecturers and university medical institutions should be made aware of the effects of study-related stress and be given appropriate advice in order to prevent depression and PN. Keywords: cognitive neuroenhancement – study-related stressors – medical students – depressive symptoms