A return to work program improves parasympathetic activity and psychiatric symptoms in workers on sick leave due to depression

Relationship between emotional words in electronic medical records and leave periods of users of a return-to-work program with depression

Introduction

We attempted to score data extracted from written medical records containing assessment results using natural language processing, and to clarify the relationship between duration of sick leave and the use of emotional words among return-to-work (RTW) program users on sick leave due to mental health problems.

Method

Participants were users of an RTW program. We extracted textual data from their electronic medical records, and gave all words a score based on the following two considerations: positivity score (the degree of positive emotion a word has) and emotion score with respect to seven emotions (sadness, anxiety, anger, disgust, trust, surprise, and joy), with the score for each emotion measured for each word. We analyzed relationships between duration of sick leave and each score.

Results

Forty-two users participated. The results showed that high positive scores (β = −0.42, p < 0.00) and high sadness scores (β = −0.60, p < 0.00) were related to a shorter duration of sick leave, and high anger score (β = 0.52, p < 0.00) was related to a longer duration of sick leave.

Conclusion

Professional assessments based on occupational therapy and natural language processing of medical records may predict the appropriate timing of RTW.

Effects of a rework program in a university hospital and predictors of work restoration and maintenance in the participants

During sickness absence, it appears necessary for psychiatric patients suffering from depression or bipolar disorder to undergo a psychiatric rehabilitation called the rework program that aids in work restoration and maintenance. However, few studies have investigated the effects of such a program and predictors of work restoration and maintenance in the participants. Here, we aimed to investigate the effects of a rework program as well as to examine whether cognitive function and mental state at the end of the rework program predict the probability of work restoration and maintenance and whether the frequency of rework program participation predicts successful work restoration and maintenance. The rework program included both patients absent from work and unemployed patients. Patients completed assessments including Trail Making Test Type B (TMT-B), the Wisconsin Card Sorting Test, and the Social Adaptation Self-Evaluation Scale just before graduating from the rework program. Simultaneously, their depressive state was assessed using the Hamilton Depression Rating scale. The patients were divided into the job group, comprising 94 patients who were able to restore their work or get a new job, and the non-job group, comprising 34 patients who were not able to do so. We found that the program was more effective in patients absent from work than in unemployed patients, TMT-B could predict work restoration and maintenance, and the frequency of rework program participation could predict work restoration but not work maintenance. Based on the findings, we propose "Yamashita's criterion" where a TMT-B completion time of 70 s is the cut-off point for work restoration. The present findings may provide useful evidence that could aid in the further development of rework program(s).

Thought Process Evolved From Rigid to Flexible in a Patient With Bipolar Disorder Via "Return to Work Program": A Case Report

ABSTRACT

In the working population, bipolar disorder can have a significant negative effect on professional relationships, attendance, functioning, and loss of productivity. In Japan, workers who take a leave due to depressive episodes receive a work-focused intervention program called the "return to work program" during their leave. A 39-year-old Japanese woman with bipolar II disorder took a third sick leave of absence. We recommended her the return to work program of our university hospital. At the beginning of the program, she had a rigid thought process toward her perceptions of her duties in the workplace and at home. Through the program, mindfulness might identify rigidity, group cognitive-behavioral therapy might correct rigidity, and self-analysis might have regained flexibility. In conclusion, a variety of effects of our return to work program might have enabled her thought process to evolve from rigid to flexible, and she showed successful reinstatement.

Factors Associated With Time to Achieve Employment Through Occupational Support Programs in Patients With Mood Disorders: 1 Year Naturalistic Study

Objective: Mood disorders cause significant work performance disability in sufferers and often lead to adverse employment outcomes in working individuals. The aim of this study was to explore factors associated with time to achieve employment through the occupational support program (OSP) for patients with mood disorders. Methods: The participants were patients admitted to the Kyorin university hospital from April 2016 to April 2019. Patients who met the criteria for major depressive disorder and depressive episode of bipolar I or II disorder according to DSM-5 and participated in the occupational therapy-based OSP for at least three sessions (one course) were included in this study. We collected demographic and clinical variables at the baseline of this study through medical records and OSP records; the variables included age, gender, diagnosis, scores of Quick Inventory of Depressive Symptomatology and Global Assessment of Functioning, the number of times of participation in the OSP, word count of the transcription task in the OSP, typographical deficiency, fatigue status and mood status after the OSP. The primary outcome was set as the time to achieve the employment within 1 year after the discharge. Results: Of the 211 patients who participated in the OSP during the survey period, 49 participants met the criteria in this study. The results showed that 14 patients achieved and the other 35 patients did not achieve the employment within 1 year of discharge from the hospital. A multivariate cox regression analysis revealed that the word count of the transcription task in the OSP (HR = 1.03, 95% CI = 1.01-1.05, p = 0.016) and mood status after the OSP (HR = 2.77, 95% CI = 1.18-6.51, p = 0.019) were significantly associated with time to achieve the employment. Conclusion: In conclusion, this study suggested that work speed and mood response in the OSP could be significant predictors for achieving employment in patients with mood disorders.

Physical Activity, Nutritional Status, and Autonomic Nervous System Activity in Healthy Young Adults with Higher Levels of Depressive Symptoms and Matched Controls without Depressive Symptoms: A Cross-Sectional Study

The aim of the present study was to comprehensively investigate physical activity (PA), nutritional status, and autonomic nervous system (ANS) activity in healthy young adults with higher levels of depressive symptoms and in sex- and age-matched controls without depressive symptoms. We recruited 35 healthy young adults with higher levels of depressive symptoms (DEP group) and 35 controls (CON group). Measurement items were daily number of steps, the duration and amount of PA ≥3 metabolic equivalents (METs), exercise habits, the consumption of tryptophan (TRP) and/or vitamin B₆-rich foods, plasma levels of total TRP and vitamin B₆ levels, and ANS activity. The DEP group had fewer daily steps, as well as duration and amount of PA ≥3 METs, than the CON group, while there was no difference in exercise habits. The intake frequency of TRP and/or vitamin B₆-rich foods and plasma vitamin B₆ levels of the DEP group were rather higher than those in the control group. Plasma TRP levels and ANS activity were comparable in the two groups. Our findings suggest that a decline in overall PA, including daily steps as well as duration and amount of moderate-to-vigorous-intensity PA, could be associated with higher levels of depressive symptoms in healthy young adults. Their dietary intake of TRP and/or vitamin B₆-rich foods was adequate, and there was no ANS activity dysfunction.