Effects of internet-based cognitive behavioural therapy and physical exercise on sick leave and employment in primary care patients with depression: two subgroup analyses

Abstract

ObjectivesDepression can negatively impact work capacity, but treatment effects on sick leave and employment are unclear. This study evaluates if internet-based cognitive behavioural therapy (ICBT) or physical exercise (PE), with already reported positive effects on clinical outcome and short-term work ability, has better effects on employment, sick leave and long-term work ability compared with treatment as usual (TAU) for depressed primary care patients (German clinical trials: DRKS00008745).MethodsAfter randomisation and exclusion of patients not relevant for work-related analysis, patients were divided into two subgroups: initially unemployed (total n=118) evaluated on employment, and employed (total n=703) evaluated on long-term sick leave. Secondary outcomes were self-rated work ability and average number of sick days per month evaluated for both subgroups. Assessments (self-reports) were made at baseline and follow-up at 3 and 12 months.ResultsFor the initially unemployed subgroup, 52.6% were employed after 1 year (response rate 82%). Both PE (risk ratio (RR)=0.44; 95% CI 0.23 to 0.87) and ICBT (RR=0.37; 95% CI 0.16 to 0.84) showed lower rates compared with TAU after 3 months, but no difference was found after 1 year (PE: RR=0.97; 95% CI 0.69 to 1.57; ICBT: RR=1.23; 95% CI 0.72 to 2.13). For those with initial employment, long-term sick leave (response rate 75%) decreased from 7.8% to 6.5%, but neither PE (RR=1.4; 95% CI 0.52 to 3.74) nor ICBT (RR=0.99; 95% CI 0.39 to 2.46) decreased more than TAU, although a temporary positive effect for PE was found. All groups increased self-rated work ability with no differences found.ConclusionsNo long-term effects were found for the initially unemployed on employment status or for the initially employed on sick leave. New types of interventions need to be explored.

Effectiveness of internet-delivered cognitive behavioural therapy in reducing sickness absence among young employees with depressive symptoms: study protocol for a large-scale pragmatic randomised controlled trial

“…A reanalysis of data from five Australian randomised controlled trials (RCTs) showed that iCBT was associated with reduced self-reported sickness absence days among adults with depression or generalised anxiety disorder 33. In contrast, three recent studies indicated that there were no significant differences in sickness absence between those adults with depressive symptoms who were treated with iCBT and those receiving care as usual (CAU) in a primary care26 34 or in an occupational setting 35. However, in previous studies sickness absence was self-reported.…”

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“…Die fundiertere Diagnosestellung von Fachärzten kann wiederum zur Folge haben, dass die Rekonvaleszenzzeit länger eingeschätzt und somit die Krankschreibung längerfristig ausfällt. Ferner ist bekannt, dass Patienten mit einem zunehmenden Schweregrad der Depression ein vermehrtes Maß an Einschränkungen der Arbeitsfähigkeit sowie der Lebensqualität erfahren [15,17,18]. Dass Depressionen ein Hauptgrund für langfristige AU-Tage sind, wurde in der Studie von Koopmans und Kollegen beschrieben [19].…”

“…17 Ein weiterer Pluspunkt dieser Behandlungsmethode ist, dass diese Form der Krebstherapie in Zukunft die Stammzelltransplantation ersetzen könnte. 18 Die Anwendungen der virtuellen Realität 4, also der Imitation der physischen Wirklichkeit mit all ihren physikalischen Eigenschaften in einer computergenerierten, interaktiven, virtuel-len Umwelt 19 können in der Ausbildung von Medizinstudenten und der Erprobung von personalisierten Behandlungsansätzen genutzt werden. So kann mit einer -von Künstlicher Intelligenz gestützten -rechnerischen Methode die Herzfunktion modelliert (Digitaler Zwilling 20 ) und mit der interdisziplinären Integration klinischer Patientendaten können cyber-physikalisch maßgeschneiderte Behandlungen vor der konkreten Umsetzung erprobt werden.…”

Long-term effects of group exercise intervention on maximal step-up height in middle-aged female primary care patients with obesity and other cardio-metabolic risk factors

“…New research shows that dietary patterns are important for promoting skeletal muscle hypertrophy [19,20], systemic anti-inflammation and for reducing metabolic risk in older women [21], independently of time spent in moderate-to-vigorous PA [22], and that the evaluation of functional capacity can help to determine the degree of physical decline in persons with metabolic syndrome [13]. PA had similar effect on employment in patients on sick leave due to depression as usual treatment [23]. The effect of resistance training in relation to depression has not been completely determined yet [24].…”