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Effects of internet-based cognitive behavioural therapy and physical exercise on sick leave and employment in primary care patients with depression : two subgroup analyses

Kaldo, Viktor; Lundin, Andreas; Hallgren, Mats; Kraepelien, Martin; Strid, Catharina LU ; Ekblom, Örjan; Lavebratt, Catharina; Lindefors, Nils; Öjehagen, Agneta LU and Forsell, Yvonne (2018) In Occupational and environmental medicine 75(1). p.52-58
Abstract

OBJECTIVES: Depression can negatively impact work capacity, but treatment effects on sick leave and employment are unclear. This study evaluates if internet-based cognitive behavioural therapy (ICBT) or physical exercise (PE), with already reported positive effects on clinical outcome and short-term work ability, has better effects on employment, sick leave and long-term work ability compared with treatment as usual (TAU) for depressed primary care patients (German clinical trials: DRKS00008745).

METHODS: After randomisation and exclusion of patients not relevant for work-related analysis, patients were divided into two subgroups: initially unemployed (total n=118) evaluated on employment, and employed (total n=703) evaluated on... (More)

OBJECTIVES: Depression can negatively impact work capacity, but treatment effects on sick leave and employment are unclear. This study evaluates if internet-based cognitive behavioural therapy (ICBT) or physical exercise (PE), with already reported positive effects on clinical outcome and short-term work ability, has better effects on employment, sick leave and long-term work ability compared with treatment as usual (TAU) for depressed primary care patients (German clinical trials: DRKS00008745).

METHODS: After randomisation and exclusion of patients not relevant for work-related analysis, patients were divided into two subgroups: initially unemployed (total n=118) evaluated on employment, and employed (total n=703) evaluated on long-term sick leave. Secondary outcomes were self-rated work ability and average number of sick days per month evaluated for both subgroups. Assessments (self-reports) were made at baseline and follow-up at 3 and 12 months.

RESULTS: For the initially unemployed subgroup, 52.6% were employed after 1 year (response rate 82%). Both PE (risk ratio (RR)=0.44; 95% CI 0.23 to 0.87) and ICBT (RR=0.37; 95% CI 0.16 to 0.84) showed lower rates compared with TAU after 3 months, but no difference was found after 1 year (PE: RR=0.97; 95% CI 0.69 to 1.57; ICBT: RR=1.23; 95% CI 0.72 to 2.13). For those with initial employment, long-term sick leave (response rate 75%) decreased from 7.8% to 6.5%, but neither PE (RR=1.4; 95% CI 0.52 to 3.74) nor ICBT (RR=0.99; 95% CI 0.39 to 2.46) decreased more than TAU, although a temporary positive effect for PE was found. All groups increased self-rated work ability with no differences found.

CONCLUSIONS: No long-term effects were found for the initially unemployed on employment status or for the initially employed on sick leave. New types of interventions need to be explored.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
cognitive behavioral therapy, depression, internet therapy, physical exercise, return to work
in
Occupational and environmental medicine
volume
75
issue
1
pages
7 pages
publisher
BMJ Publishing Group
external identifiers
  • scopus:85039064044
ISSN
1470-7926
DOI
10.1136/oemed-2017-104326
language
English
LU publication?
yes
id
d74b8dc7-16f4-41ee-9232-5448edb704d9
date added to LUP
2018-01-24 14:24:51
date last changed
2018-01-24 14:24:51
@article{d74b8dc7-16f4-41ee-9232-5448edb704d9,
  abstract     = {<p>OBJECTIVES: Depression can negatively impact work capacity, but treatment effects on sick leave and employment are unclear. This study evaluates if internet-based cognitive behavioural therapy (ICBT) or physical exercise (PE), with already reported positive effects on clinical outcome and short-term work ability, has better effects on employment, sick leave and long-term work ability compared with treatment as usual (TAU) for depressed primary care patients (German clinical trials: DRKS00008745).</p><p>METHODS: After randomisation and exclusion of patients not relevant for work-related analysis, patients were divided into two subgroups: initially unemployed (total n=118) evaluated on employment, and employed (total n=703) evaluated on long-term sick leave. Secondary outcomes were self-rated work ability and average number of sick days per month evaluated for both subgroups. Assessments (self-reports) were made at baseline and follow-up at 3 and 12 months.</p><p>RESULTS: For the initially unemployed subgroup, 52.6% were employed after 1 year (response rate 82%). Both PE (risk ratio (RR)=0.44; 95% CI 0.23 to 0.87) and ICBT (RR=0.37; 95% CI 0.16 to 0.84) showed lower rates compared with TAU after 3 months, but no difference was found after 1 year (PE: RR=0.97; 95% CI 0.69 to 1.57; ICBT: RR=1.23; 95% CI 0.72 to 2.13). For those with initial employment, long-term sick leave (response rate 75%) decreased from 7.8% to 6.5%, but neither PE (RR=1.4; 95% CI 0.52 to 3.74) nor ICBT (RR=0.99; 95% CI 0.39 to 2.46) decreased more than TAU, although a temporary positive effect for PE was found. All groups increased self-rated work ability with no differences found.</p><p>CONCLUSIONS: No long-term effects were found for the initially unemployed on employment status or for the initially employed on sick leave. New types of interventions need to be explored.</p>},
  author       = {Kaldo, Viktor and Lundin, Andreas and Hallgren, Mats and Kraepelien, Martin and Strid, Catharina and Ekblom, Örjan and Lavebratt, Catharina and Lindefors, Nils and Öjehagen, Agneta and Forsell, Yvonne},
  issn         = {1470-7926},
  keyword      = {cognitive behavioral therapy,depression,internet therapy,physical exercise,return to work},
  language     = {eng},
  number       = {1},
  pages        = {52--58},
  publisher    = {BMJ Publishing Group},
  series       = {Occupational and environmental medicine},
  title        = {Effects of internet-based cognitive behavioural therapy and physical exercise on sick leave and employment in primary care patients with depression : two subgroup analyses},
  url          = {http://dx.doi.org/10.1136/oemed-2017-104326},
  volume       = {75},
  year         = {2018},
}