Ervasti Jenni, Vahtera Jussi, Pentti Jaana, Oksanen Tuula, Ahola Kirsi, Kivekäs Teija, Kivimäki Mika, Virtanen Marianna
From the Development of Work and Organizations (Ervasti, Vahtera, Pentti, Oksanen, Ahola, Kivekäs, Kivimäki, Virtanen). Finnish Institute of Occupational Health, Helsinki, Finland; Department of Public Health (Vahtera), University of Turku and Turku University Hospital, Turku, Finland; Department of Epidemiology and Public Health (Kivimäki), University College London, London, UK; and Department of Behavioral Sciences (Kivimäki), University of Helsinki, Helsinki, Finland.
Psychosom Med. 2015 Feb-Mar;77(2):126-35. doi: 10.1097/PSY.0000000000000138.
Among employees with depression, diagnoses of other psychiatric and somatic conditions are common. However, few studies have examined whether the combined presence of depression and other psychiatric or somatic disorders adversely affects return to work after depression-related absence from work.
We examined the association of present and recent psychiatric and somatic conditions and return to work after depression-related absence in a cohort of 9908 Finnish public sector employees with at least one such episode. The data included a total of 14,101 episodes during the period January 2005 to December 2011.
A total of 89% (n = 12,486) of depression-related absence episodes ended in return to work during the follow-up. For those episodes, the median length of absence was 34 days (interquartile range, 20-69 days). After adjustment for sex, age, socioeconomic status, and type of employment contract, present or recent psychiatric disorders other than depression (hazard ratio [HR] = 0.78, 95% confidence interval [CI] = 0.74-0.83), cancer (HR = 0.66, 95% CI = 0.47-0.92), diabetes (HR = 0.73, 95% CI = 0.62-0.86), cardiovascular disease (HR = 0.78, 95% CI = 0.62-0.99), hypertension (HR = 0.76, 95% CI = 0.67-0.85), musculoskeletal disorders (HR = 0.82, 95% CI = 0.77-0.87), and asthma (HR = 0.84, 95% CI = 0.75-0.94) were all associated with a lower likelihood of returning to work compared with depression episodes without other conditions.
Among employees with depression-related absence, return to work is delayed in the presence of other psychiatric and somatic conditions. These findings suggest that other diseases should be taken into account when evaluating the outcome of depression-related absence. Randomized controlled trials are needed to examine whether integrated treatment of mental and physical disorders improves successful return to work after depression.
在患有抑郁症的员工中，其他精神和躯体疾病的诊断很常见。然而，很少有研究探讨抑郁症与其他精神或躯体疾病同时存在是否会对因抑郁症缺勤后重返工作产生不利影响。
我们在9908名至少有一次此类发作的芬兰公共部门员工队列中，研究了当前和近期的精神和躯体疾病与因抑郁症缺勤后重返工作之间的关联。数据包括2005年1月至2011年12月期间总共14101次发作。
在随访期间，总共89%（n = 12486）的与抑郁症相关的缺勤发作以重返工作告终。对于这些发作，缺勤的中位时长为34天（四分位间距，20 - 69天）。在对性别、年龄、社会经济地位和雇佣合同类型进行调整后，除抑郁症外的当前或近期精神疾病（风险比[HR] = 0.78，95%置信区间[CI] = 0.74 - 0.83）、癌症（HR = 0.66，95% CI = 0.47 - 0.92）、糖尿病（HR = 0.73，95% CI = 0.62 - 0.86）、心血管疾病（HR = 0.78，95% CI = 0.62 - 0.99）、高血压（HR = 0.76，95% CI = 0.67 - 0.85）、肌肉骨骼疾病（HR = 0.82，95% CI = 0.77 - 0.87）和哮喘（HR = 0.84，95% CI = 0.75 - 0.94）与没有其他疾病的抑郁症发作相比，重返工作的可能性均较低。
在因抑郁症缺勤的员工中，存在其他精神和躯体疾病会延迟重返工作。这些发现表明，在评估与抑郁症相关缺勤的结果时应考虑其他疾病。需要进行随机对照试验，以研究精神和躯体疾病的综合治疗是否能改善抑郁症后成功重返工作的情况。
