[Interpersonal psychotherapy for work-related stress depressive disorders]

[Effectiveness of the Internet-Based, Job-Related Aftercare GSA-Online Following Inpatient Psychosomatic Rehabilitation: Results of a Randomized Controlled Trial]

PURPOSE

In order to sustain the treatment results of medical rehabilitation in the long term and to support the transfer of learned strategies into everyday life, outpatient aftercare is often indicated. This is especially true for psychosomatic rehabilitation patients with occupational stress, for whom reintegration into working life is a particular challenge. Since access to care services close to home is limited, internet-based aftercare interventions offer the possibility of timely and flexible aftercare tailored to the patient's needs. In a randomized controlled trial, the internet-based job-related aftercare GSA-Online proved to be effective across indications with regard to job-related and health-related outcome criteria. The aim of the present study is to examine these outcome criteria in a subsample of patients undergoing inpatient psychosomatic rehabilitation.

METHODS

Occupationally stressed rehabilitation inpatients were assigned to the intervention (IG) or control group (CG) by means of cluster randomization after meeting the inclusion criteria and participating an inpatient vocational stress management training. After discharge from rehabilitation, patients in the IG were given access to GSA-Online for twelve weeks. In the intervention, maladaptive social interactions in the workplace were identified with the help of self-written blog posts and addressed with the help of therapeutic comments. The active CG received access to selected online information on health-promoting behaviors. Target measures included subjective prognosis of gainful employment (SPE), depressiveness (PHQ-9), and anxiety (GAD-7). Self-report measures were assessed at the end of aftercare and at follow-up (twelve months after the end of rehabilitation). Missing values were replaced using multiple imputation.

RESULTS

Ninety-one percent of the IG (N=89) and 70% of the CG (N=106) logged on to the website at least once. There were no group differences in the subjective prognosis of gainful employment at the end of aftercare but a trend toward more optimistic scores in the IG at follow-up. Significantly lower psychological distress was observed in the IG, especially with regard to anxiety (at both measuring points) but also with regard to depressive symptoms (follow-up) and experience of stress (end of intervention).

CONCLUSION

In the subsample of psychosomatic rehabilitation, the internet-based, job-related aftercare GSA-Online led to a significant reduction in psychological symptoms. Regarding the subjective prognosis of gainful employment, there was at least a trend in favor of IG. A larger sample is needed to more closely examine the results of this exploratory evaluation. Additionally measures to increase adherence in the IG should be explored.

Lang U. How a Depressive Medical Doctor Profited in the Long-Term from a New and Short Psychological Group-Treatment against Major Depressive Disorder

Background: Individuals suffering from major depressive disorder (MDD) often describe workplace-related stress as one of the main causes of their disorder. Here, we present the story of a 33 year old “Bob” (a pseudonym) who suffered from a moderate (Hamilton-21 = 18) major depressive episode. Workplace-related stress seemed to be the main stressor for Bob at the time. We were interested in long-lasting effects of a newly established group called “work-related interpersonal Psychotherapy, W-IPT”. W-IPT consists of eight weekly 90 min sessions. The follow-ups were 12 weeks after the group-treatment and 18 months later. Bob was chosen because he agreed in advance to participate in a follow-up. We were interested if the group-treatment of W-IPT also has a persistent positive effect. Case presentation: We present the case of a 33-year-old man “Bob”. He was included in our previous published pilot-study 2020 with diagnosed moderate MDD, and he attended the group treatment. This case report focuses on a follow-up period of 18 months. A structured clinical interview for DSM-IV was carried out in order to be included in the study, and no comorbid diagnoses were detected. Conclusions: However, the psychotherapeutic effects in this case seem enduring and prolonged. Of course, additional research to study the long-term effects of W-IPT is needed, and more patients need to be included.

Workplace-Related Interpersonal Group Psychotherapy to Improve Life at Work in Individuals With Major Depressive Disorders: A Randomized Interventional Pilot Study

OBJECTIVES

Individuals suffering from major depressive disorder (MDD) often report workplace-related stress as the major cause of their disorder. Accordingly, workplace-related stress was established as a fifth psychosocial problem area of Interpersonal Psychotherapy (workplace-related Interpersonal Psychotherapy, W-IPT). The aim of the study was to investigate the influence of W-IPT on depressive symptoms and on workplace-related issues in individuals with MDD compared to a treatment-as-usual (TAU) condition.

METHODS

A total of 27 individuals with MDD (mean age = 43 years, 48% males) were randomly assigned either to eight weekly group sessions of W-IPT or to the TAU condition. At baseline, 8 weeks later at the end of the intervention, and 20 weeks later at follow-up, the Hamilton Rating Scale for Depression was conducted. In addition, the participants completed the Beck Depression Inventory, the Work Ability Index (WAI), the Return to Work Attitude (RTW-SE), and the Insomnia Severity Index (ISI).

RESULTS

Symptoms of depression in experts' ratings as well as in self-rated ratings decreased over time, but more so in the W-IPT condition compared to the TAU condition [experts rating: large effect size (d = 1.25) and self-assessment: large effect sizes (d = 0.94)]. The subjective ability to work (WAI) [medium effect size (d = 0.68)], self-efficacy to returning to work RTW-SE [medium effect size (d = 0.57)], and subjective symptoms of insomnia (ISI) [large effect size (d = 1.15)] increased over time, but again more so in the W-IPT condition compared to the TAU condition. The effects of the intervention remained stable from the end of the intervention to follow-up.

CONCLUSIONS

The pattern of results of this pilot study suggests that a newly established fifth IPT focus on workplace-related stress appeared to be particularly efficient in individuals with MDD due to work-related stress in reducing depressive symptoms and reducing sleep complaints as well as in improving occupational outcomes.

Interpersonal Psychotherapy vs. Treatment as Usual for Major Depression Related to Work Stress: A Pilot Randomized Controlled Study

Background: Depressive disorders are among the leading causes of sick leave and long-term work incapacity in most modern countries. Work related stress is described by patients as the most common context of depression. It is vital to know what types of treatments are effective in improving work related problems and occupational health. However, there is only limited evidence on work-focused interventions. Methods: The aim of our study was to evaluate the feasibility and generate first data on the effectiveness of Interpersonal Psychotherapy (IPT) adapted as a group program to focus on the work context (W-IPT). In total, 28 outpatients (22 women; M = 49.8 years old) with Major Depressive Disorder related to work stress were randomized to 8 weekly group sessions of W-IPT or to treatment as usual (TAU; guideline oriented treatment). Primary endpoint was the Hamilton Rating Scale for Depression (HRSD-24) score. Key secondary endpoints were, among others, Beck Depression Inventory (BDI-II), Work Ability Index (WAI), Return to Work Attitude (RTW-SE), and the Effort-Reward-Imbalance (ERI). In addition, we evaluated the participants' overall satisfaction with the W-IPT program by two items. A follow-up assessment was conducted 3 months after end of acute treatment. Results: W-IPT was significantly more effective than TAU in reducing clinician-assessed depressive symptoms at follow-up (HRSD-24 W-IPT/TAU: M = 6.6/12.0, SE: 1.46/2.17, t_{(df = 1)} = -2.24, p = 0.035, d = 0.79) and self-assessed depression (BDI-II W-IPT/TAU post-treatment: M = 8.8/18.8, SE: 1.69/2.70, t_{(df = 1)} = -3.82, p = 0.001, d = 1.28; follow-up: M = 8.8/16.1, SE: 1.62/2.26, t_{(df = 1)} = -2.62, p = 0.015, d = 0.99). Furthermore, W-IPT was superior in improving work-ability (WAI), return-to-work attitude (RTW-SE), and the effort-reward-ratio (ERI). No dropouts were observed in both groups. The vast majority (89 percent) of participants in the W-IPT condition were "very satisfied" with the program, although wishing for a greater number of sessions (75 percent). Conclusions: A work-focused IPT program for the treatment of depression associated to work stress was feasible and highly acceptable. W-IPT turned out to be more effective than standard treatment in reducing depression and work-related problems. However, further evidence in a multicenter trial extending this pilot study is necessary.

Managing the (In)visibility of Chronic Illness at Work: Dialogism, Parody, and Reported Speech

Interactionally, the workplace may be dilemmatic for a person with "invisible" chronic illness. Risks of stigmatization exist if they disclose their condition to colleagues. Meanwhile, not disclosing threatens well-being and entitlements. Using Bakhtin's dialogism as a theoretical framework, we explored these social aspects of illness: inductively analyzing narratives from 20 participants with multiple sclerosis (MS). Capitalizing on concepts from dialogical and conversation analysis, links between (in)visibility, knowledge, and belief were examined with respect to symptoms and co-worker judgment. Perceived medical legitimacy creates a core social dilemma. At the intersection of genre and action, participants systematically used parody to subvert the traditional workplace hierarchy. "Oh-prefaced" direct reported speech (OPDRS) was deployed to exaggerate workplace interactions, undermining managers/colleagues who misattributed (in)visible symptoms. Parodic OPDRS index emotive interactional dilemmas. As subversions of organizational power, OPDRS denote those very areas where employees feel disempowered. Sensitivity to OPDRS can provide diagnostic support and complement evaluation frameworks.

[Burnout: a useful diagnosis?]

In psychiatry, burnout is a relevant phenomenon. A large number of individuals is feeling overburdened at work. In contrast to mental disorders, the term 'burnout' is not perceived as stigmatizing, making it therefore easier for afflicted persons to seek help. The term 'burnout syndrome' was mentioned 1974 for the first time in scientific literature. Today, there is a range of partially contradictory definitions and explanations for burnout and the burnout syndrome, respectively. In most studies, burnout is assessed by the Maslach Burnout Inventory, which is neither useful for determining the degree of pathology nor for distinguishing burnout from mental disorders such as depression. It is expected that the burnout syndrome will not be used in modern diagnostic classification systems, because of its unclear definition and conceptual contradictions. On these grounds, it appears reasonable to define burnout as long-term professional overload and a noteworthy risk factor for physical diseases and mental disorders.

[Prevention and treatment of mental disorders in the workplace: staged spectrum of care]

Mental disorders connected with work stress are of growing importance for the health care system. Following a heated debate on burnout in Germany, at present various approaches on how to prevent the development of burnout syndromes, how to ensure a need adapted treatment for employees with a manifest disorder and how the process of returning to work already addresses aspects of secondary prevention are under discussion. This leads to different fields of activities for company health management and the health care system and structural improvements are essential.