Depression in the workplace: a systematic review of evidence-based prevention strategies

Long-term effect of a care manager on work ability for patients with depression – the PRIM-CARE RCT

BACKGROUND: Collaborative care with a care manager in primary care improves care. OBJECTIVE: To study whether care manager support leads to improved work ability, decreased job strain and reduced time of sick leave among primary care patients with depression. METHODS: A clinical effectiveness study of care managers for depression patients seeking care in primary care was conducted in a RCT 2014 –2016. Patients in the intervention group were assigned a care manager. In the 12-month follow-up, patients with employment (n = 269; intervention n = 142, control n = 127) were studied concerning work ability, job strain and sick leave. RESULTS: An association was shown between reduction of depressive symptoms and improved work ability for the entire group. At 12-month follow-up a statistically significant difference of reduction of depressive symptoms was seen between the groups (MADRS-S: intervention 10.8 vs control 13.1, p = 0.05) as well as increased quality of life (EQ-5D: intervention 0.77 vs control 0.70, p = 0.04). In the intervention group, a concordance was found between the patient’s prediction of return to work and the actual return to work (91%for intervention and 68 %for control group, p = 0.047). CONCLUSIONS: Compared to usual care, the care manager does not seem to further improve perception of work ability, job strain or perception of social support per se among the patients despite a long-term effect on depression symptoms. The lack of a long-term effect regarding these aspects may be due to the fact that care manager support was only provided during the first three months.

Workplace interventions to reduce depression and anxiety in small and medium-sized enterprises: A systematic review

BACKGROUND

Depression and anxiety are the most prevalent mental health difficulties in the workplace, costing the global economy $1 trillion each year. Evidence indicates that symptoms may be reduced by interventions in the workplace. This paper is the first to systematically review psychosocial interventions for depression, anxiety, and suicidal ideation and behaviours in small-to medium-size enterprises (SMEs).

METHODS

A systematic search following PRISMA guidelines, registered in PROSPERO (CRD42020156275), was conducted for psychosocial interventions targeting depression, anxiety, and suicidal ideation/behaviour in SMEs. The PubMed, PsycINFO, Scopus, and two specific occupational health databases were searched, as well as four databases for grey literature, without time limit until 2nd December 2019.

RESULTS

In total, 1283 records were identified, 70 were retained for full-text screening, and seven met the inclusion criteria: three randomised controlled trials (RCTs), three before and after designs and one non-randomised trial, comprising 5111 participants. Study quality was low to moderate according to the Quality Assessment Tool for Quantitative Studies. Five studies showed a reduction in depression and anxiety symptoms using techniques based on cognitive behavioural therapy (CBT), two reported no significant change.

LIMITATIONS

Low number and high heterogeneity of interventions and outcomes, high attrition and lack of rigorous RCTs.

CONCLUSIONS

Preliminary evidence indicates CBT-based interventions can be effective in targeting symptoms of depression and anxiety in SME employees. There may be unique challenges to implementing programmes in SMEs. Further research is needed in this important area.

Evidence available for patient-identified priorities in depression research: results of 11 rapid responses

OBJECTIVES

Patient priority setting projects (PPSPs) can reduce research agenda bias. A key element of PPSPs is a review of available literature to determine if the proposed research priorities have been addressed, identify research gaps, recognise opportunities for knowledge translation (KT) and avoid duplication of research efforts. We conducted rapid responses for 11 patient-identified priorities in depression to provide a map of the existing evidence.

DESIGN

Eleven rapid responses.

DATA SOURCES

Single electronic database (PubMed).

ELIGIBILITY CRITERIA

Each rapid response had unique eligibility criteria. For study designs, we used a stepwise inclusion process that started with systematic reviews (SRs) if available, then randomised controlled trials and observational studies as necessary.

RESULTS

For all but one of the rapid responses we identified existing SRs (median 7 SRs per rapid response, range 0-179). There were questions where extensive evidence exists (ie, hundreds of primary studies), yet uncertainties remain. For example, there is evidence supporting the effectiveness of many non-pharmacological interventions (including psychological interventions and exercise) to reduce depressive symptoms. However, targeted research is needed that addresses comparative effectiveness of promising interventions, specific populations of interest (eg, children, minority groups) and adverse effects.

CONCLUSIONS

We identified an extensive body of evidence addressing patient priorities in depression and mapped the results and limitations of existing evidence, areas of uncertainty and general directions for future research. This work can serve as a solid foundation to guide future research in depression and KT activities. Integrated knowledge syntheses bring value to the PPSP process; however, the role of knowledge synthesis in PPSPs and methodological approaches are not well defined at present.

An outreach collaborative model for early identification and treatment of mental disorder in Danish workplaces

BACKGROUND

Depression and anxiety are prevalent mental disorders among the working population with potentially high personal and financial cost. The overall aim of this study was to test the applicability of an outreach collaborative model for early identification and treatment of clinical and sub-clinical mental disorders among Danish employees. This applicability was examined by I) investigating the fractions of identified and treated clinical and subclinical cases, II) describing the distribution and characteristics of cases identified and III) investigating the effect of allocated treatment.

METHODS

A longitudinal study design with four assessments (T0-T3) over 16 months was applied. Self-reporting questionnaires probing for psychopathology were distributed to all employees in six consecutively enrolled companies at the four time points. Employees meeting the screening criteria at T1 were assessed diagnostically. Subjects diagnosed with a clinical mental disorder were allocated to outpatient psychiatric treatment, and subjects with subclinical conditions were allocated to preventive cognitive behavioural therapy. Follow-up was conducted 6 and 12 months after initiation of treatment. We used chi-squared test and F-test to compare the different groups on baseline characteristics and mixed effects linear regression to analyse the treatment effects.

RESULTS

Forty (6.8%) of the 586 responders at T1 were diagnosed with a clinical mental disorder and referred to outpatient psychiatric treatment. Thirty-three (5.6%) were affected by a subclinical condition and referred to preventive treatment. Nearly two-thirds (63%) of the employees diagnosed with a clinical condition had never received treatment before. Symptom severity decreased significantly for both treated groups until follow-up. When compared to a composed control group, subclinical cases displayed a more rapid initial significant symptomatic decrease on the global symptom scale (coefs = - 0.914, 95% CI [- 1.754, - 0,075]) and anxiety sub-scale (coefs = - 1.043, 95% CI [- 2.021, - 0.066]). This did not apply to the clinical cases as no significant difference in change were identified.

CONCLUSIONS

The outreach collaborative model demonstrated an applicability to identify both clinical and subclinical cases, among these a high number of employees with an unmet need for treatment. We found evidence of a positive initial effect on symptomatology from the allocated preventive treatment among the subclinical cases, but not for clinical cases.

TRIAL REGISTRATION

Retrospectively registered at December 18, 2018 at clinicaltrials.gov, identifier: NCT03786328 .

Indicated Prevention Interventions in the Workplace for Depressive Symptoms: A Systematic Review and Meta-analysis

CONTEXT

Depressive symptoms are highly prevalent and cause substantive morbidities and loss of functioning among employees. Depression may be prevented at its early stages. However, there is a paucity of information regarding indicated preventive interventions for depression among employees. The objective of this review is to examine the effectiveness of indicated interventions for the reduction of depressive symptoms in the workplace.

EVIDENCE ACQUISITION

A systematic review and meta-analysis of articles published between January 2000 and September 2017 was conducted using major electronic databases, including PubMed/MEDLINE, PsycINFO, EMBASE, SOCINDEX, and ABI/ProQuest. Studies were selected based on a set of predefined inclusion criteria. Primary outcome measures were depressive symptomatology, and the interventions were preventive in nature. Studies were pooled based on the intervention type and the effect size was measured using the standardized mean difference.

EVIDENCE SYNTHESIS

A computer and hand search of the literature yielded 4,462 papers, from which 16 trials were identified to be suitable for meta-analysis. Eight of 16 studies reported significant effects for workplace preventive interventions targeting depressive symptoms in which six were cognitive behavioral therapy (CBT)-based interventions and two were non-CBT-based interventions. Small to medium effect sizes were found for both CBT- and non-CBT-based interventions (standardized mean difference= -0.44, 95% CI= -0.61, -0.26, I²=62.1% and standardized mean difference= -0.32, 95% CI= -0.59, -0.06, I²=58%, respectively).

CONCLUSIONS

This review demonstrates that indicated interventions can significantly reduce the level of depressive symptoms among workers. The implementation of evidence-based workplace interventions should consequently be considered to prevent the development of depressive symptoms among employees.

Feasibility and acceptability of strategies to address mental health and mental ill-health in the Australian coal mining industry

Background

To evaluate the feasibility, acceptability and effectiveness of implementing a peer-based, multi-component mental health program in the Australian coal mining industry.

Methods

The multicomponent program included MATES in mining (a peer-based mental health and suicide prevention program) and supervisor training. Eight Australian coal mines participated in the research, with four mines receiving the mental health program. Primary outcome variables including mental health stigma, help-seeking behaviour and perception of the workplace commitment to mental health were measured prior to program implementation, and then again 10 months following using a paper based survey. Process evaluation of the mental health program was measured using a pre-test/post-test survey.

Results

MATES in mining 1275 miners participated in the MATES general awareness and connector training. Participants were more confident that they could identify a workmate experiencing mental ill-health; help a workmate, family member or themselves identify where to get support and were more willing to start a conversation with a workmate about their mental health. Supervisor training 117 supervisors completed the supervisor training and were subsequently more confident that they could: identify someone experiencing mental ill-health in the workplace; identify and recommend support services to a person experiencing mental ill-health; and have an effective conversation about performance issues that may be due to mental ill-health.

Conclusions

Our findings show evidence to support the use of peer-based mental health programs in the mining industry, and for male-dominated industry more broadly.

Systematic review of universal and targeted workplace interventions for depression

Depression is increasingly being recognised as a significant mental health problem in the workplace contributing to productivity loss and economic burden to organisations. This paper reviews recently published randomised controlled trials (RCTs) of universal and targeted interventions to reduce depression in the workplace. Studies were identified through searches of EMBASE, MEDLINE/PubMed, PsycINFO, PsycARTICLES Full Text, and Global Health and Social Policy and Practice databases. Studies were included if they included an RCT of a workplace intervention for employees targeting depression as the primary outcome. Twenty-two published RCTs investigating interventions utilising various therapeutic approaches were identified. The cognitive behavioural therapy (CBT) approach is the most frequently used in the workplace, while interventions that combine different therapeutic approaches showed the most promising results. A universal intervention in the workplace that combines CBT and coping flexibility recorded the highest effect size (d=1.45 at 4 months’ follow-up). Most interventions were delivered in group format and showed low attrition rates compared with other delivery formats. Although all studies reviewed were RCTs, the quality of reporting is low. Interventions using different therapeutic approaches with different modes of delivery have been used. Most of these interventions were shown to reduce depression levels among employees in the workplace, particularly those that combine more than one therapeutic approaches.

Neural basis of individual differences in the response to mental stress: a magnetoencephalography study

Stress is a risk factor for the onset of mental disorders. Although stress response varies across individuals, the mechanism of individual differences remains unclear. Here, we investigated the neural basis of individual differences in response to mental stress using magnetoencephalography (MEG). Twenty healthy male volunteers completed the Temperament and Character Inventory (TCI). The experiment included two types of tasks: a non-stress-inducing task and a stress-inducing task. During these tasks, participants passively viewed non-stress-inducing images and stress-inducing images, respectively, and MEG was recorded. Before and after each task, MEG and electrocardiography were recorded and subjective ratings were obtained. We grouped participants according to Novelty seeking (NS) - tendency to be exploratory, and Harm avoidance (HA) - tendency to be cautious. Participants with high NS and low HA (n = 10) assessed by TCI had a different neural response to stress than those with low NS and high HA (n = 10). Event-related desynchronization (ERD) in the beta frequency band was observed only in participants with high NS and low HA in the brain region extending from Brodmann's area 31 (including the posterior cingulate cortex and precuneus) from 200 to 350 ms after the onset of picture presentation in the stress-inducing task. Individual variation in personality traits (NS and HA) was associated with the neural response to mental stress. These findings increase our understanding of the psychological and neural basis of individual differences in the stress response, and will contribute to development of the psychotherapeutic approaches to stress-related disorders.

Black and Blue: Depression and African American Men

Depression is a common mental disorder affecting individuals. Although many strides have been made in the area of depression, little is known about depression in special populations, especially African American men. African American men often differ in their presentation of depression and are often misdiagnosed. African American men are at greater risk for depression, but they are less likely to participate in mental health care. This article explores depression in African American by looking at environmental factors, sigma, role, and other unique to this populations, such as John Henryism. Interventions to encourage early screening and participation in care are also discussed.

Does long-term experience of nonstandard employment increase the incidence of depression in the elderly?

Objectives:

Our prospective study aimed to elucidate the effect of long-term experience of nonstandard employment status on the incidence of depression in elderly population using the Korean Longitudinal Study of Ageing (KLoSA) study.

Methods:

This study used the first- to fourth-wave cohorts of KLoSA. After the exclusion of the unemployed and participants who experienced a change in employment status during the follow-up periods, we analyzed a total of 1,817 participants. Employment contracts were assessed by self-reported questions:standard or nonstandard employment. The short form of the Center for Epidemiologic Studies Depression Scale (CES-D) served as the outcome measure. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards models to evaluate the association between standard/nonstandard employees and development of depression.

Results:

The mean age of the participants was 53.90 (±7.21) years. We observed that nonstandard employment significantly increased the risk of depression. Compared with standard employees, nonstandard employees had a 1.5-fold elevated risk for depression after adjusting for age, gender, CES-D score at baseline, household income, occupation category, current marital status, number of living siblings, perceived health status, and chronic diseases [HR=1.461, 95% CI= (1.184, 1.805) ]. Moreover, regardless of other individual characteristics, the elevated risk of depression was observed among all kinds of nonstandard workers, such as temporary and day workers, full-time and part-time workers, and directly employed and dispatched labor.

Conclusions:

The 6-year follow-up study revealed that long-term experience of nonstandard employment status increased the risk of depression in elderly population in Korea.

Closing the mental health gap in low-income settings by building research capacity: perspectives from Mozambique

BACKGROUND

Neuropsychiatric disorders are the leading cause of disability worldwide, accounting for 22.7% of all years lived with disability. Despite this global burden, fewer than 25% of affected individuals ever access mental health treatment; in low-income settings, access is much lower, although nonallopathic interventions through traditional healers are common in many venues. Three main barriers to reducing the gap between individuals who need mental health treatment and those who have access to it include stigma and lack of awareness, limited material and human resources, and insufficient research capacity. We argue that investment in dissemination and implementation research is critical to face these barriers. Dissemination and implementation research can improve mental health care in low-income settings by facilitating the adaptation of effective treatment interventions to new settings, particularly when adapting specialist-led interventions developed in high-resource countries to settings with few, if any, mental health professionals. Emerging evidence from other low-income settings suggests that lay providers can be trained to detect mental disorders and deliver basic psychotherapeutic and psychopharmacological interventions when supervised by an expert.

OBJECTIVES

We describe a new North-South and South-South research partnership between Universidade Eduardo Mondlane (Mozambique), Columbia University (United States), Vanderbilt University (United States), and Universidade Federal de São Paulo (Brazil), to build research capacity in Mozambique and other Portuguese-speaking African countries.

CONCLUSIONS

Mozambique has both the political commitment and available resources for mental health, but inadequate research capacity and workforce limits the country's ability to assess local needs, adapt and test interventions, and identify implementation strategies that can be used to effectively bring evidence-based mental health interventions to scale within the public sector. Global training and research partnerships are critical to building capacity, promoting bilateral learning between and among low- and high-income settings, ultimately reducing the mental health treatment gap worldwide.

Long-term effects of mental disorders on employment in the National Comorbidity Survey ten-year follow-up

PURPOSE

Although significant negative associations of mental disorders with employment have been documented in epidemiological research, much of this research was based on cross-sectional samples and focused only on severe and persistent mental disorders. The present study examined the longitudinal associations of more common mental disorders with employment.

METHODS

Data on the associations of common mental disorders with employment are presented here from 4501 respondents in the National Comorbidity Survey panel study, a two-wave community epidemiological survey of respondents aged 15-54 at baseline (1990-1992) who were re-interviewed in 2001-2003 and were employed, unemployed in the labor force or student at baseline. Lifetime mental disorders at baseline and disorders with onset after baseline were assessed with the Composite International Diagnostic Interview, a fully structured interview that assessed lifetime prevalence of internalizing fear disorders (panic, phobias), anxiety/misery disorders (major depression, generalized anxiety disorder, post-traumatic stress disorder), externalizing disorders (conduct disorder, alcohol and illicit drug abuse-dependence), and bipolar disorder.

RESULTS

Both baseline lifetime disorders and disorders with onsets after baseline were associated with significantly reduced odds of subsequent employment among respondents who were either employed or students at baseline. Population projections based on the assumption that these associations represented causal effects suggest that the mental disorders considered here were associated with 1.7-3.2 million adults being unemployed in the US population at follow-up.

CONCLUSIONS

Expanded access to treatment among current employees and students with mental disorders might lead to improved employment outcomes in these segments of the population.

Experiences of work and sickness absence in employees with depression: an interpretative phenomenological analysis

PURPOSE

The experience of employment with depression is explored to develop understanding of the mediators that may influence the management of depression-related sickness absence and improve theoretical understanding.

METHOD

Data were collected from seven semi-structured interviews and Interpretative Phenomenological Analysis used to explore the data.

RESULTS

Three interrelated themes were drawn from the participants' accounts: (1) the interaction between depression and work; (2) illness beliefs; and (3) organisational context and depression. The analysis revealed that participants appeared to hold five key perceptions about their depression and work: low control in the workplace; lack of line manager support; diminishing ability to work; the need to address depressive symptoms; and perceptions of depression. Their strength resulted in individuals reaching sickness absence thresholds. The themes and participants' accounts of their work and sickness absence and return to work behaviour are discussed in relation to relevant theory and evidence to understand how these perceptions and beliefs mediate behaviour.

CONCLUSION

Individuals' health (illness representations) and work beliefs (outcome expectancies and self-efficacy for work tasks and management of health at work) appear to influence individuals' sickness absence decisions and experiences and these are mediated by individuals' experiences of organisational policies, line manager support and the messages and actions of GPs.

Depression among physicians working in public healthcare in Belo Horizonte, Brazil

PURPOSE

Prevalence of depressive disorders has been reported among physicians in a number of different settings. The aim of the present study is to assess the prevalence of self-reported depression and its associated factors among physicians working in the public healthcare system of Belo Horizonte, Minas Gerais state, Brazil.

METHODS

A cross-sectional survey was carried out in 2009 to investigate individual and occupational dimensions of depressive disorders in a group of physicians working at several municipal healthcare units. The percentage of physicians that self-reported a confirmed diagnosis of depression by another physician was used as the prevalence proportion; the Poisson regression univariate and multivariate models were applied to study factors associated with depression.

RESULTS

The response rate was 81.2 %, of which 12.0 % reported depression confirmed by another physician. Reports of RSI/WMSD (p < 0.001) and passive work (p < 0.05) were positively and independently associated with the outcome.

CONCLUSIONS

Our data bring valuable information that may help guide interventions and health-promoting activities for physicians by indicating concrete measures to change working conditions that affect mental health.

Receiving workplace mental health accommodations and the outcome of mental disorders in employees with a depressive and/or anxiety disorder

OBJECTIVES

To investigate the association between receiving workplace accommodations and the 1-year risk of mood/anxiety disorders.

METHODS

A general population sample of employees in Alberta, Canada, with a prior or current mental disorder (N = 715) was observed for 1 year. Mental disorders were determined on the basis of the Diagnostic and Statistical Manual, 4th revision, criteria.

RESULTS

In participants who needed but did not receive any accommodations, 30.8% had a mood/anxiety disorder 1 year later. Receiving needed accommodations was associated with a lowered risk of 24.5%. Logistic regression showed that the percentage of having accommodation needs met was significantly associated with the risk of a mental disorder 1 year later (odds ratio = 0.27; 95% confidence interval = 0.11 to 0.65).

CONCLUSIONS

Receiving needed accommodations was associated with better outcomes for mental disorders. Studies are needed to confirm the effectiveness of specific accommodations for enhancing the prognosis of mood/anxiety disorders.

McCann T, Cvetkovski S, F. Jorm A. A multifaceted intervention to improve mental health literacy in employees of a multi-campus university: a cluster randomised trial

Purpose

– The purpose of this study was to assess whether a multifaceted intervention could improve mental health literacy, facilitate help seeking and reduce psychological distress and alcohol misuse in staff of a multi-campus university in Australia.

Design/methodology/approach

– In this cluster randomised trial (ACTRN12610001027000), nine campuses were paired, with one of each pair randomly assigned to either intervention or control. Interventions (which were whole-of-campus) included e-mails, posters, campus events, factsheets/booklets and mental health first aid training courses. A monitoring sample of staff were recruited from each campus. Participants had a 20-minute computer-assisted telephone interview at baseline, and at the end of academic years 1 and 2. The interview assessed mental health literacy, help seeking for mental health problems, psychological distress and alcohol use. The primary outcomes were depression and anxiety levels and alcohol use and pertained to the individual level. Six campuses were randomised to intervention and three to control and all campuses were included in the analysis.

Findings

– There were no effects on depression and anxiety levels and alcohol use. Recall of intervention elements was greater in the intervention group at the end of the two-year assessment period. Staff in the intervention group showed better recognition of depression, greater knowledge of the National Health and Medical Research Council guidelines for safe levels of drinking and a greater intention to seek help for alcohol misuse from a general practitioner.

Originality/value

– Future interventions should involve more focused interventions that include consideration of working conditions and their influence on mental health, as well as addressing mental illness among employees, regardless of cause.

Prevalence and correlates of psychological distress in a large and diverse public sector workforce: baseline results from Partnering Healthy@Work

Background

Depressive and anxiety disorders are common among working adults and costly to employers and individuals. Mental health screening is often an important initial strategy, but the resultant data are often of unknown representativeness and difficult to interpret. In a public sector workforce, this study used a brief screener for depression/anxiety to: a) compare prevalence of high psychological distress obtained from a researcher survey with an employer survey and population norms and b) verify whether expected correlates were observed in a screening setting.

Methods

Participants were public servants working for an Australian state government. High psychological distress (Kessler-10 ≥22) stratified by age and sex was compared for a random weighted sample researcher survey (n = 3406) and an anonymous volunteer employer survey (n = 7715). Prevalence ratios (PR) were estimated from log binomial regression.

Results

Referencing the researcher survey, prevalence of high psychological distress was greater by age and sex in the employer survey but was only dependably higher for men when compared with population norms. Modelling suggested this may be due to work stress (effort-reward imbalance) (PR = 3.19, 95% CI 1.45-7.01) and casual/fixed-term employment (PR 2.64, 95% CI 1.26-5.56).

Conclusions

Depression and anxiety screening using typical employer survey methods could overestimate prevalence but expected correlates are observed in a screening setting. Guidance for employers on screening and interpretation should be provided to encourage engagement with mental health prevention and treatment programs in the workplace.

Changes in psychosocial work environment and depressive symptoms: a prospective study in junior physicians

BACKGROUND

We examined the impact of changes in the psychosocial work environment on depressive symptoms in a sample of junior physicians, a high risk group for stress and mental disorders.

METHODS

This is a three-wave prospective study in 417 junior physicians during their residency in German hospitals. The psychosocial work environment was measured by the Effort-Reward Imbalance (ERI) Questionnaire at Waves 1 and 2, and the depressive symptoms were assessed with the State-Trait Depression Scales at all three waves. Multivariate linear regression was applied for prospective associations between ERI across Waves 1 and 2, and baseline-adjusted depressive symptoms at Wave 3.

RESULTS

Compared with the ERI scores at Wave 1, at Wave 2, and mean scores between the two waves, the baseline-adjusted ERI change scores between the two waves showed slightly better statistical power, predicting depressive symptoms at Wave 3 (β = 0.78, 95% CI = 0.38-1.18 for increased ERI per SD, β = 0.64, 95% CI = 0.22-1.06 for increased effort per SD, β = -0.65, 95% CI = -1.06 to -0.24 for increased reward per SD, and β = 0.68, 95% CI = 0.27-1.09 for increased overcommitment per SD).

CONCLUSIONS

Negative changes in the psychosocial work environment, specifically increased ERI, are associated with depressive symptoms in German junior physicians. Reducing the non-reciprocity of working life, particularly improving reward at work, may have beneficial effects on prevention of mental health problems in the hospital workplace.

The Impact of an Early Eclectic Rehabilitative Intervention on Symptoms in First Episode Depression among Employed People

Objective. To evaluate the effect of an early vocational-orientated eclectic intervention on beck depression inventory (BDI) scores compared to treatment as usual in first ever depressive episode among employed people. Design. A randomized controlled trial comparing the rehabilitative intervention and the conventional treatment. Subjects. The subjects came from occupational health care units. Methods. Employees were sent to a rehabilitation center after being screened for depression using the BDI. They were diagnosed using the structured clinical interview for DSM-IV. The participating subjects (N = 283) were randomized into intervention and control groups. The intervention group received eclectic early depression intervention treatment (N = 134) and the control group was treated in the conventional way (N = 100). They were followed for one year. Results. The mean decrease in BDI scores within the intervention group was from 20.8 to 11.6 and within the control group from 19.3 to 10.8. BDI score decreased by 10 or more points in 64% of the participants in the intervention group and in 53% of the control group (P = 0.013). Conclusions. There was some evidence that early eclectic intervention in first ever episode depression may be more effective than conventional treatments among working age people in employment.

To what extent do single symptoms from a depression rating scale predict risk of long-term sickness absence among employees who are free of clinical depression?

PURPOSE

Depression rating scales have predicted long-term sickness absence (LTSA) in previous studies. With this study, we investigated to what extent single symptoms from a depression rating scale predicted LTSA among employees who were free of clinical depression.

METHODS

We studied 6,670 female employees in the Danish eldercare sector. Frequency of 12 depressive symptoms over the last 2 weeks was assessed with the Major Depression Inventory. A symptom was considered as elevated if it was present at least "slightly more than half of the time." Data were linked to a national register on LTSA (≥3 weeks). We calculated hazard ratios (HR) from Cox's proportional hazard models to analyze whether a symptom predicted time to onset of LTSA during a 1-year follow-up. Analyses were adjusted for age, family status, health behaviors, occupational group, and previous LTSA.

RESULTS

Of the 12 symptoms, three predicted LTSA after adjustment for covariates: "felt low in spirits and sad" (HR = 1.41, 95 % CI = 1.05-1.89), "felt lacking in energy and strength" (HR = 1.33, 95 % CI = 1.08-1.64), and "had trouble sleeping at night" (HR = 1.38, 95 % CI = 1.09-1.74).

CONCLUSION

Among female eldercare workers free of clinical depression, feelings of low spirits and sadness, feelings of lack of energy and strength, and sleep disturbances predict risk of LTSA. Interventions that decrease the prevalence of these symptoms might contribute to a reduction in LTSA in this population.

Depressive symptoms in junior doctors: a follow-up study on work-related determinants

PURPOSE

The study investigates the long-term effects of accumulated working conditions on depressive symptoms in junior doctors. Drawing on the Job Demand-Control-Support model, this study aims to identify personal and job-related determinants for self-reported depression in junior doctors-a professional group that is vulnerable to depression.

METHODS

We conducted a prospective cohort study with measures of work characteristics and depressive symptoms over three time-points among hospital doctors during postgraduate specialty training in Germany. Participants were 415 junior doctors with full-time contract (47.5% women; mean age, 30.5 years). The outcome was depressive symptoms assessed with the Spielberger State-Depression Scale. Odds ratios (OR) were computed to analyse the cumulative effect of initial depressive symptoms scores, demographic variables, and working characteristics across T1 and T2 on subsequent depressive symptoms at T3.

RESULTS

The percentage of junior doctors reporting depressive symptoms scores above a critical value varied between 12.0% at T1, 10.4% at T2, and 13.3% at T3; N = 34 doctors (8.19%) were classified as incident cases during the observation period. Elevated depressive symptoms at T3 were positively predicted by depressive symptoms scores across T1 and T2 (OR: 1.37; 95% confidence interval: 1.25-1.50) and negatively by professional tenure (0.54; 0.31-0.96), free weekends (0.52; 0.28-0.97), and job autonomy (0.35; 0.18-0.65).

CONCLUSIONS

After controlling for demographic and working time influences, findings suggest that junior doctors' perceived job autonomy is negatively associated with future depressive symptoms. Enhancing job control emerges as a promising strategy to lower the risk of depression during first years of professional practice.