Sullivan Michael J L, Adams Heather, Thibault Pascal, Corbière Marc, Stanish William D
Department of Psychology, Université de Montréal, Montréal, Quebéc, Canada.
J Occup Rehabil. 2006 Mar;16(1):63-74. doi: 10.1007/s10926-005-9013-0.
The present study examined the recovery trajectories of a group of mildly depressed and moderately-severely depressed injured workers enrolled in a 10-week community-based rehabilitation program.
A sample of 168 individuals (75 women, 93 men) with a disabling musculoskeletal pain condition participated in the research. On the basis of BDI-II (1) scores at pre-treatment assessment, patients were classified as either mildly (BDI-II =9-16; N=68) or moderately-severely depressed (BDI-II >16; N: 100).
Both groups showed significant reductions in depression, but individuals in the (initially) moderately-severely depressed group were more likely to score in the depressed range of the BDI-II at post-treatment than individuals who were initially mildly depressed. For the mildly depressed group, early treatment reductions in pain catastrophizing, and perceived disability predicted improvement in depression scores. For the moderately-severely depressed group, none of the early treatment changes predicted improvement in depression; only late treatment reductions in pain catastrophizing and fear of movement/re-injury predicted improvement in depression. Chi-square analysis revealed that patients who were no longer depressed at post-treatment had the highest probability of returning to work (91%), followed by (post-treatment) mildly depressed patients (60%), and finally (post-treatment) moderately-severely depressed patients (26%), chi(2)=38.9, p < 0.001.
In order to maximize return to work potential, the content, structure and duration of rehabilitation programs requires modification as a function of the injured workers level of the depression severity.
本研究考察了一组参与为期10周社区康复项目的轻度抑郁和中度至重度抑郁受伤工人的康复轨迹。
168名患有致残性肌肉骨骼疼痛疾病的个体（75名女性，93名男性）参与了该研究。根据治疗前评估时的贝克抑郁量表第二版（BDI-II）得分，患者被分为轻度抑郁（BDI-II = 9 - 16；N = 68）或中度至重度抑郁（BDI-II > 16；N = 100）。
两组的抑郁症状均有显著减轻，但（最初）中度至重度抑郁组的个体在治疗后的BDI-II得分处于抑郁范围内的可能性高于最初轻度抑郁的个体。对于轻度抑郁组，治疗早期疼痛灾难化及感知到的残疾程度降低可预测抑郁得分改善。对于中度至重度抑郁组，治疗早期的变化均无法预测抑郁症状改善；只有治疗后期疼痛灾难化及对运动/再受伤恐惧程度降低可预测抑郁症状改善。卡方分析显示，治疗后不再抑郁的患者重返工作的可能性最高（91%），其次是（治疗后）轻度抑郁患者（60%），最后是（治疗后）中度至重度抑郁患者（26%），χ² = 38.9，p < 0.001。
为了最大限度地提高重返工作的潜力，康复项目的内容、结构和时长需要根据受伤工人的抑郁严重程度进行调整。
