Invalidität und Tod bei Erwerbsfähigen mit Depressionen

Effectiveness of a return to work intervention after occupational disability retirement due to depression and anxiety

Depression and anxiety disorders are the most common cause for disability retirement among people of middle age. The following social disintegration can have an additional detrimental effect on subjects' psychological well-being, which further reduces their chances for recovery. Long-term disability could be avoidable in many cases as depression and anxiety disorders don't have an etiology that makes permanent loss of function inevitable. This prospective cohort study tests the long-term effects of an intervention addressed at these young disablement retirees. Forty-one subjects each in the experimental and control group were followed-up on over a period of 24 months. The intervention had positive effects on psychological well-being. More subjects returned to work than controls. The effects were still present at one year follow-up. These findings show that an individually tailored return-to-work intervention is a useful, sustainable and economically advantageous therapeutic tool to get out of disability retirement due to mental illness even after all other therapeutic tools have failed.

A Return-to-Work Intervention for Prematurely Retired Depression or Anxiety Disorder Patients

Background: Depression and anxiety disorders are the most common cause for premature retirement of people of middle age. These people are expelled from the workforce. The following social disintegration can have an additional detrimental effect on subjects' psychological well-being which further reduces the chance to re-enter the workforce. Depression and anxiety in general need not be regarded as irreversible causes of disability. Therefore, long-term disability should be avoidable in many cases. This two-arm prospective controlled study tests a novel approach for those who have become economically inactive due to their illness with the goal to improve psychological well-being and return to work. Forty-one subjects were followed-up on over a period of 12 months and compared to 41 control cases. ANOVA for repeated measures showed that experimental subjects' psychological well-being and work ability was much better after the intervention than in the control group. These findings show that an individually tailored return-to-work intervention can be a useful therapeutic tool even after retirement.

[Mental health and work: concepts, evidence and implications for research and practice]

This paper reviews the concepts, evidence and implications regarding mental health at the workplace. The theoretical background with the most common theories (e.g. effort-reward imbalance model and job-demand control model) are briefly reviewed and findings from systematic reviews and from a meta-analysis regarding psychosocial factors at the workplace and common mental disorders, which indicate that psychosocial factors increase the risk of mental disorder are outlined. Implications for primary prevention as well as early intervention and treatment following a stepped care model including a variety of agents from different backgrounds are discussed. Implications to enhance research in the field are outlined.

Comorbidities significantly impact patients' preferences for psoriasis treatments

BACKGROUND

Non-adherence rates are high among patients with psoriasis, partly because of discordance between recommended treatments and individual preferences.

OBJECTIVES

Our aim was to assess the impact of comorbidities on patients' preferences for psoriasis treatments.

METHODS

A computer-based conjoint analysis experiment was conducted to analyze preferences of patients with psoriasis (N = 163) for treatment outcome attributes (probability, magnitude and duration of benefit; probability, severity and reversibility of side effects) and process attributes (treatment location, frequency, duration, delivery method, individual cost). The impact of comorbidities (psoriatic arthritis, cardiovascular disease, diabetes, and depression) on relative importance scores of each attribute was assessed by analyses of variance, post hoc test, and multivariate regression analysis.

RESULTS

Among the participants included (58.9% males, mean age 49.3 yrs), 27% suffered from psoriatic arthritis, 13.5% from cardiovascular disease, 8% from diabetes, and 12.9% from depression. Preferences for treatment attributes varied significantly depending on comorbidities. Participants with psoriatic arthritis cared most about the probability of benefit (β 0.166; P = .037), whereas those participants with cardiovascular disease were highly concerned about the probability of side effects (β 0.179; P = .046). For participants with depression, treatment duration (β 0.163; P = .047), and individual cost (P = .023) were highly important.

LIMITATIONS

Only patients with moderate and severe psoriasis treated at a university medical center were included.

CONCLUSIONS

Integrating patients' preferences into shared decision-making may facilitate treatment adherence and optimize outcomes. Addressing patients' comorbidities, particularly depression, may be a currently neglected opportunity to improve care.