让我们重新投入工作：抑郁症后重返工作的生存分析。
Let's get back to work: survival analysis on the return-to-work after depression.
机构信息
Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam.
出版信息
Neuropsychiatr Dis Treat. 2013;9:1637-45. doi: 10.2147/NDT.S49883. Epub 2013 Oct 25.
PURPOSE
Absence from work due to mental disorders is substantial. Additionally, long-term absence from work is associated with a reduced probability of return-to-work (RTW). Major depressive disorder (MDD) is a prevalent condition in Dutch occupational health care settings. An early estimate of the prognosis regarding RTW in patients with MDD could serve both as a point of departure for the identification of high-risk cases and as an instrument to monitor the course of the disorder and of RTW. In the current study, we aimed to assess the added value of health-related quality of life (HRQoL) and severity of depression to predict the time to RTW.
PATIENTS AND METHODS
Data were derived from a prospective longitudinal study aimed to evaluate the cost effectiveness of a collaborative care treatment in sick-listed workers with MDD. We included demographic, job-related, and health-related variables. Severity of depression was measured using the Patient Health Questionnaire Depression Scale-9 (PHQ-9). HRQoL was measured using two generic preference-based instruments, the EuroQol 5-Dimension (EQ-5D™) and the Medical Outcomes Study Short Form Health Survey (SF-36). A survival model was constructed by applying different survival functions to assess the best fit for the data. Additionally, survival analyses were performed to assess the added value of the two HRQoL measures and depression severity for predicting RTW.
RESULTS
Females and older patients had a longer time to RTW. The same was true for patients with a full-time job and patients with more decision latitude. Patients in a management position and patients with more social support had a shorter time to RTW. Severity of depression was not predictive for the time to RTW. HRQoL measured by the SF-36 was a significant predictor for the time to RTW.
CONCLUSION
HRQoL emerged as a significant predictor for the time to RTW. However, severity of depression was not predictive for the time to RTW. These results suggest the importance of assessing HRQoL in addition to severity of disease to assess functionality.
目的
精神障碍导致的旷工现象较为严重。此外，长期旷工与重返工作岗位（RTW）的可能性降低有关。在荷兰的职业健康护理环境中，重度抑郁症（MDD）是一种普遍存在的疾病。对 MDD 患者 RTW 预后的早期估计既可以作为识别高风险病例的起点，也可以作为监测疾病和 RTW 进程的工具。在本研究中，我们旨在评估健康相关生活质量（HRQoL）和抑郁严重程度对预测 RTW 时间的附加价值。
患者和方法
数据来自一项旨在评估协作护理治疗对 MDD 请病假工人成本效益的前瞻性纵向研究。我们纳入了人口统计学、与工作相关和与健康相关的变量。抑郁严重程度使用患者健康问卷抑郁量表-9（PHQ-9）进行测量。HRQoL 使用两种通用的偏好为基础的工具进行测量，即欧洲五维健康量表（EQ-5D™）和医疗结局研究短表健康调查（SF-36）。通过应用不同的生存函数构建生存模型，以评估数据的最佳拟合度。此外，进行生存分析以评估两种 HRQoL 测量和抑郁严重程度对预测 RTW 的附加价值。
结果
女性和年龄较大的患者 RTW 时间较长。全职工作和决策自由度较高的患者也是如此。处于管理岗位的患者和获得更多社会支持的患者 RTW 时间较短。抑郁严重程度与 RTW 时间无相关性。SF-36 测量的 HRQoL 是 RTW 时间的显著预测因素。
结论
HRQoL 是 RTW 时间的显著预测因素。然而，抑郁严重程度与 RTW 时间无相关性。这些结果表明，除了评估疾病严重程度外，评估 HRQoL 对于评估功能的重要性。
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