Vlasveld Moniek C, Anema Johannes R, Beekman Aartjan T F, van Mechelen Willem, Hoedeman Rob, van Marwijk Harm W J, Rutten Frans F, Hakkaart-van Roijen Leona, van der Feltz-Cornelis Christina M
Netherlands Institute of Mental Health and Addiction (Trimbos-institute), Utrecht, The Netherlands.
BMC Health Serv Res. 2008 May 5;8:99. doi: 10.1186/1472-6963-8-99.
Major depressive disorder (MDD) has major consequences for both patients and society, particularly in terms of needlessly long sick leave and reduced functioning. Although evidence-based treatments for MDD are available, they show disappointing results when implemented in daily practice. A focus on work is also lacking in the treatment of depressive disorder as well as communication of general practitioners (GPs) and other health care professionals with occupational physicians (OPs). The OP may play a more important role in the recovery of patients with MDD. Purpose of the present study is to tackle these obstacles by applying a collaborative care model, which has proven to be effective in the USA, with a focus on return to work (RTW). From a societal perspective, the (cost)effectiveness of this collaborative care treatment, as a way of transmural care, will be evaluated in depressed patients on sick leave in the occupational health setting.
METHODS/DESIGN: A randomised controlled trial in which the treatment of MDD in the occupational health setting will be evaluated in the Netherlands. A transmural collaborative care model, including Problem Solving Treatment (PST), a workplace intervention, antidepressant medication and manual guided self-help will be compared with care as usual (CAU). 126 Patients with MDD on sick leave between 4 and 12 weeks will be included in the study. Care in the intervention group will be provided by a multidisciplinary team of a trained OP-care manager and a consultant psychiatrist. The treatment is separated from the sickness certification. Data will be collected by means of questionnaires at baseline and at 3, 6, 9 and 12 months after baseline. Primary outcome measure is reduction of depressive symptoms, secondary outcome measure is time to RTW, tertiary outcome measure is the cost effectiveness.
The high burden of MDD and the high level of sickness absence among people with MDD contribute to the relevance of this study. The intervention is an innovative approach, with trained OPs in a new role as care managers in the treatment of MDD. If this intervention proves to be cost-effective, implementation will be very relevant for individual patients as well as for society.
ISRCTN78462860.
重度抑郁症（MDD）对患者和社会都有重大影响，尤其是在不必要的长期病假和功能减退方面。尽管有基于证据的MDD治疗方法，但在日常实践中实施时效果却令人失望。抑郁症治疗中也缺乏对工作的关注，全科医生（GPs）和其他医疗保健专业人员与职业医师（OPs）之间的沟通也存在问题。OP在MDD患者的康复中可能发挥更重要的作用。本研究的目的是通过应用一种协作护理模式来克服这些障碍，该模式在美国已被证明是有效的，重点是重返工作岗位（RTW）。从社会角度来看，这种协作护理治疗作为一种跨部门护理方式的（成本）效益将在职业健康环境中对休病假的抑郁症患者进行评估。
方法/设计：一项随机对照试验，将在荷兰评估职业健康环境中MDD的治疗情况。将一种跨部门协作护理模式，包括问题解决疗法（PST）、工作场所干预、抗抑郁药物治疗和手册指导自助，与常规护理（CAU）进行比较。126名休病假4至12周的MDD患者将被纳入研究。干预组的护理将由训练有素的OP护理经理和顾问精神科医生组成的多学科团队提供。治疗与疾病证明分开。数据将通过基线时以及基线后3、6、9和12个月的问卷调查收集。主要结局指标是抑郁症状的减轻，次要结局指标是RTW时间，第三结局指标是成本效益。
MDD的高负担以及MDD患者的高病假率使得本研究具有相关性。该干预是一种创新方法，训练有素的OP在治疗MDD中担任新的护理经理角色。如果这种干预被证明具有成本效益，那么实施对个体患者和社会都将非常重要。
ISRCTN78462860。
