Integration of a Return-to-Work Module in Cognitive Behavioral Therapy in Patients With Major Depressive Disorder and Long-Term Sick Leave—A Feasibility Study

Abstract

Objective: Major depressive disorder (MDD) has a negative impact on individuals ability to work, and is often associated with long phases of sick leave. Consequently, interventions facilitating return to work in patients with MDD gained increased attention during last decades. We here report results of a feasibility study where a "return-to-work" (RTW) module published by Lagerveld and colleagues in the Netherlands was integrated in cognitive behavioral therapy in depressed patients with long-term sick leaves in Germany. Our study aimed to answer the following questions: Is RTW accepted by patients and therapists? Do RTW interventions lead to return-to-work? Do depressive symptoms improve? Methods: Twenty patients with MDD (15 female; mean age, 45 ± 9 years) were included. Patients received cognitive-behavioral therapy with an integrated, standardized return-towork module (W-CBT). Psychometric measurements included Beck Depression Inventory (BDI-2) and work ability index (WAI). Further, time until return-to-work was measured, and acceptability of W-CBT was assessed using visual analog scales and open questions. Results: Mean sick leave days in depressed patients were 127 ± 97, and 75% of patients were sick leave for more than 6 weeks. After treatment, 11/20 patients had returned to their former occupation (55%), 5/20 were in occupational re-deployment or started a new job (25%), and 3/20 patients were still on sick leave (2/20; 10%) or received a pension (1/20; 5%). One patient dropped out. BDI-2 sum score improved from 23 ± 8 to 8 ± 5 (p < 0.001), and WAI improved from 28 ± 6 to 39 ± 7 (p < 0.001). Acceptability of W-CBT in patients and therapists was high. Conclusion: We here demonstrate feasibility and acceptability of an RTW module integrated in standard cognitive behavioral therapy. W-CBT leads to improvement of work ability, paralleled by improvement of depressive symptoms. Despite the limitations of this uncontrolled study, the results propose that W-CBT may be feasible in the treatment of depressed patients with long sick leaves and justify a controlled trial evaluating the efficacy of W-CBT.

Healthy Minds: Group Cognitive-Behavioral Intervention for Sustainable Return to Work After a Sick Leave Due to Depression

“…Our results are close to those reported by Ito et al's [17] pilot study, whereby work-focused cognitive behavioral group therapy (8 sessions) for Japanese workers on sick leave due to depression resulted in improvements in anxiety and depressive symptoms, as well as in social functioning from pre to post intervention. Our results are also close to those of Winter et al [46], who conducted a pilot study with 20 German workers with a major depression who received cognitivebehavioral therapy, with an integrated, standardized RTW module (W-CBT). They also found that work ability significantly improved and depressive symptoms were significantly reduced in their pre-post comparison.…”

“…Given that depressive and anxiety symptoms can negatively impact one's RTW, it is important to consider both clinical and work outcomes when evaluating RTW and work sustainability. Recent developments for preventing sustained or recurrent depressive symptoms after RTW can be found in the literature, mostly favoring interventions using cognitive behavioral concepts and strategies, either in group or individual formats [16,17,46]. According to Arends et al's [24] trajectory analyses following RTW after a CMD-related sick leave, workers continue to experience work functioning and clinical challenges over time, even at one-year follow-up.…”

Return-to-work interventions for persons/employees with mental illnesses

“…Regarding interventions addressing the individual we found eight different interventions [15,16 ▪ ,19,24–26,27 ▪ ,30] from Europe, the United States, Canada and Japan. Most of them were complex and elaborate interventions being based on cognitive behavioural therapy and/or vocational rehabilitation.…”

“…Participants (employees with psychological complaints) can be transferred to the program by their occupational health physicians, their supervisors or by self-assignment. Winter et al [19] evaluated the feasibility of a CBT program that focussed on RTW over an average of 26 weeks.…”

Employers With Metabolic Syndrome and Increased Depression/Anxiety Severity Profit Most From Structured Exercise Intervention for Work Ability and Quality of Life.

“…However, studies concerning the effects of exercise interventions on work ability in psychologically burdened, non-clinical samples are scarce. Depression and anxiety are associated with more sick-days at the workplace, earlier retirement, and less productivity compared to individuals without diagnosed depression and anxiety (41)(42)(43)(44). Some studies have been published highlighting psychotherapeutic approaches to improve return-to-work in patients with depression and anxiety, either using face-to-face psychotherapy or internet based devices (45,46).…”