Randomized Controlled Trial

. 2015 Jul-Aug;37(4):352-9.

doi: 10.1016/j.genhosppsych.2015.04.001. Epub 2015 Apr 8.

Improving work outcomes of dysthymia (persistent depressive disorder) in an employed population

David A Adler¹, Debra Lerner², Zachary L Visco³, Annabel Greenhill⁴, Hong Chang⁵, Elina Cymerman⁶, Francisca Azocar⁷, William H Rogers⁸

Affiliations

¹ Program on Health, Work, and Productivity, Tufts Medical Center, 800 Washington Street, #345, Boston, MA 02111, USA; Tufts University School of Medicine, 145 Harrison Avenue, Boston, MA 02111, USA; Department of Psychiatry, Tufts Medical Center, 800 Washington Street, #345, Boston, MA 02111, USA. Electronic address: dadler@tuftsmedicalcenter.org.
² Program on Health, Work, and Productivity, Tufts Medical Center, 800 Washington Street, #345, Boston, MA 02111, USA; Tufts University School of Medicine, 145 Harrison Avenue, Boston, MA 02111, USA; Department of Psychiatry, Tufts Medical Center, 800 Washington Street, #345, Boston, MA 02111, USA. Electronic address: dlerner@tuftsmedicalcenter.org.
³ Program on Health, Work, and Productivity, Tufts Medical Center, 800 Washington Street, #345, Boston, MA 02111, USA. Electronic address: zvisco@tuftsmedicalcenter.org.
⁴ Program on Health, Work, and Productivity, Tufts Medical Center, 800 Washington Street, #345, Boston, MA 02111, USA. Electronic address: agreenhill@tuftsmedicalcenter.org.
⁵ Program on Health, Work, and Productivity, Tufts Medical Center, 800 Washington Street, #345, Boston, MA 02111, USA. Electronic address: hchang@tuftsmedicalcenter.org.
⁶ Department of Psychiatry, Tufts Medical Center, 800 Washington Street, #345, Boston, MA 02111, USA. Electronic address: ecymerman@tuftsmedicalcenter.org.
⁷ OptumHealth, 425 Market Street, 14th Floor San Francisco, CA 94105, USA. Electronic address: francisca.azocar@optum.com.
⁸ Program on Health, Work, and Productivity, Tufts Medical Center, 800 Washington Street, #345, Boston, MA 02111, USA. Electronic address: whrogers@tuftsmedicalcenter.org.

PMID: 25892151
PMCID: PMC4457606
DOI: 10.1016/j.genhosppsych.2015.04.001

Randomized Controlled Trial

Improving work outcomes of dysthymia (persistent depressive disorder) in an employed population

David A Adler et al. Gen Hosp Psychiatry. 2015 Jul-Aug.

. 2015 Jul-Aug;37(4):352-9.

doi: 10.1016/j.genhosppsych.2015.04.001. Epub 2015 Apr 8.

Authors

David A Adler¹, Debra Lerner², Zachary L Visco³, Annabel Greenhill⁴, Hong Chang⁵, Elina Cymerman⁶, Francisca Azocar⁷, William H Rogers⁸

Affiliations

¹ Program on Health, Work, and Productivity, Tufts Medical Center, 800 Washington Street, #345, Boston, MA 02111, USA; Tufts University School of Medicine, 145 Harrison Avenue, Boston, MA 02111, USA; Department of Psychiatry, Tufts Medical Center, 800 Washington Street, #345, Boston, MA 02111, USA. Electronic address: dadler@tuftsmedicalcenter.org.
² Program on Health, Work, and Productivity, Tufts Medical Center, 800 Washington Street, #345, Boston, MA 02111, USA; Tufts University School of Medicine, 145 Harrison Avenue, Boston, MA 02111, USA; Department of Psychiatry, Tufts Medical Center, 800 Washington Street, #345, Boston, MA 02111, USA. Electronic address: dlerner@tuftsmedicalcenter.org.
³ Program on Health, Work, and Productivity, Tufts Medical Center, 800 Washington Street, #345, Boston, MA 02111, USA. Electronic address: zvisco@tuftsmedicalcenter.org.
⁴ Program on Health, Work, and Productivity, Tufts Medical Center, 800 Washington Street, #345, Boston, MA 02111, USA. Electronic address: agreenhill@tuftsmedicalcenter.org.
⁵ Program on Health, Work, and Productivity, Tufts Medical Center, 800 Washington Street, #345, Boston, MA 02111, USA. Electronic address: hchang@tuftsmedicalcenter.org.
⁶ Department of Psychiatry, Tufts Medical Center, 800 Washington Street, #345, Boston, MA 02111, USA. Electronic address: ecymerman@tuftsmedicalcenter.org.
⁷ OptumHealth, 425 Market Street, 14th Floor San Francisco, CA 94105, USA. Electronic address: francisca.azocar@optum.com.
⁸ Program on Health, Work, and Productivity, Tufts Medical Center, 800 Washington Street, #345, Boston, MA 02111, USA. Electronic address: whrogers@tuftsmedicalcenter.org.

PMID: 25892151
PMCID: PMC4457606
DOI: 10.1016/j.genhosppsych.2015.04.001

Abstract

Objective: To test the effectiveness of a work-focused intervention (WFI) on the work outcomes of employed adults with dysthymia.

Method: This subgroup analysis from a randomized controlled trial compares an initial sample of 167 employees (age: ≥45 years), screened for dysthymia using the PC-SAD without current major depressive disorder randomized to WFI (n=85) or usual care (UC) (n=82). Study sites included 19 employers and five additional organizations. Telephone-based WFI counseling (eight, twice monthly 50-min sessions) provided work coaching and modification, care coordination and cognitive behavioral therapy. Adjusted mixed effects models compared the WFI vs. UC group preintervention to 4-month postintervention change in at-work limitations measured by the Work Limitations Questionnaire. Secondary outcome analysis compared the change in self-reported absences and depression symptom severity (Patient Health Questionnaire PHQ-9 scores).

Results: Work productivity loss scores improved 43.0% in the WFI group vs. 4.8% in UC (difference in change: P<.001). Absence days declined by 58.3% in WFI vs. 0.0% in UC (difference in change: P=.09). Mean PHQ-9 depression symptom severity declined 44.2% in WFI vs. 5.3% in UC (difference in change: P<.001).

Conclusion: At 4 months, the WFI was more effective than UC on two of the three outcomes. It could be an important mental and functional health improvement resource for the employed dysthymic population.

Trial registration: ClinicalTrials.gov NCT01163890.

Keywords: Dysthymia; Economic issues; Mood disorder; Outcome studies; Work productivity.

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Conflict of interest statement

There are no other conflicts of interest to report.

Figures

**Figure 1**
CONSORT Diagram for Randomized Controlled Trial (RCT) of an Experimental Work-Focused Intervention for Employed Adults with Depression and Work Limitations

**Figure 2**
Percentage Change in Presenteeism, Absenteeism and Depression Symptom Severity: Pre-Intervention to Post-Intervention^a,b ^a Models are adjusted for study site, baseline mean age, percent male, percent White, percent married, percent white collar occupation, mean number of comorbidities, percent full-time employed, and mean scores of model dependent variable. ^b The differences in the percent improvement from baseline between the Work-Focused Intervention and Usual Care were all significant at the p<0.001 level, except for the Productivity Loss Due to Absence, which was significant at the p<0.01 level.

See this image and copyright information in PMC

References

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Improving work outcomes of dysthymia (persistent depressive disorder) in an employed population

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Improving work outcomes of dysthymia (persistent depressive disorder) in an employed population

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