Schene Aart H, Koeter Maarten W J, Kikkert Martijn J, Swinkels Jan A, McCrone Paul
Department of Psychiatry, Programme for Mood Disorders, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Psychol Med. 2007 Mar;37(3):351-62. doi: 10.1017/S0033291706009366. Epub 2006 Nov 20.
Major depression has far-reaching consequences for work functioning and absenteeism. In most cases depression is treated by medication and clinical management. The addition of occupational therapy (OT) might improve outcome. We determined the cost-effectiveness of the addition of OT to treatment as usual (TAU).
Sixty-two adults with major depression and a mean absenteeism of 242 days were randomized to TAU (out-patient psychiatric treatment) or TAU+OT [6 months, including (i) diagnostic phase with occupational history and work reintegration plan, and (ii) therapeutic phase with individual sessions and group sessions]. Main outcome domains were depression, work resumption, work stress and costs. Assessments were at baseline and at 3, 6, 12 and 42 months.
The addition of OT to TAU: (i) did not improve depression outcome, (ii) resulted in a reduction in work-loss days during the first 18 months, (iii) did not increase work stress, and (iv) had a 75.5% probability of being more cost-effective than TAU alone.
Addition of OT to good clinical practice does not improve depression outcome, improves productivity without increasing work stress and is superior to TAU in terms of cost-effectiveness.
重度抑郁症对工作功能和旷工有深远影响。在大多数情况下，抑郁症通过药物治疗和临床管理来治疗。增加职业治疗（OT）可能会改善治疗效果。我们确定了在常规治疗（TAU）基础上加用OT的成本效益。
62名患有重度抑郁症且平均旷工242天的成年人被随机分为TAU组（门诊精神科治疗）或TAU + OT组[为期6个月，包括（i）职业病史和工作恢复计划的诊断阶段，以及（ii）个体治疗和小组治疗的治疗阶段]。主要结局指标包括抑郁、恢复工作、工作压力和成本。在基线以及3、6、12和42个月时进行评估。
在TAU基础上加用OT：（i）未改善抑郁结局，（ii）在最初18个月内减少了误工天数，（iii）未增加工作压力，并且（iv）比单独使用TAU更具成本效益的概率为75.5%。
在良好的临床实践基础上加用OT并未改善抑郁结局，提高了生产力且未增加工作压力，在成本效益方面优于TAU。
