Winter Lotta, Geldmacher Julia, Plücker-Boss Katharina, Kahl Kai G
Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
Front Psychiatry. 2020 Jun 3;11:512. doi: 10.3389/fpsyt.2020.00512. eCollection 2020.
Major depressive disorder (MDD) has a negative impact on individuals ability to work, and is often associated with long phases of sick leave. Consequently, interventions facilitating return to work in patients with MDD gained increased attention during last decades. We here report results of a feasibility study where a "return-to-work" (RTW) module published by Lagerveld and colleagues in the Netherlands was integrated in cognitive behavioral therapy in depressed patients with long-term sick leaves in Germany. Our study aimed to answer the following questions: Is RTW accepted by patients and therapists? Do RTW interventions lead to return-to-work? Do depressive symptoms improve?
Twenty patients with MDD (15 female; mean age, 45 ± 9 years) were included. Patients received cognitive-behavioral therapy with an integrated, standardized return-to-work module (W-CBT). Psychometric measurements included Beck Depression Inventory (BDI-2) and work ability index (WAI). Further, time until return-to-work was measured, and acceptability of W-CBT was assessed using visual analog scales and open questions.
Mean sick leave days in depressed patients were 127 ± 97, and 75% of patients were sick leave for more than 6 weeks. After treatment, 11/20 patients had returned to their former occupation (55%), 5/20 were in occupational re-deployment or started a new job (25%), and 3/20 patients were still on sick leave (2/20; 10%) or received a pension (1/20; 5%). One patient dropped out. BDI-2 sum score improved from 23 ± 8 to 8 ± 5 (p < 0.001), and WAI improved from 28 ± 6 to 39 ± 7 (p < 0.001). Acceptability of W-CBT in patients and therapists was high.
We here demonstrate feasibility and acceptability of an RTW module integrated in standard cognitive behavioral therapy. W-CBT leads to improvement of work ability, paralleled by improvement of depressive symptoms. Despite the limitations of this uncontrolled study, the results propose that W-CBT may be feasible in the treatment of depressed patients with long sick leaves and justify a controlled trial evaluating the efficacy of W-CBT.
重度抑郁症（MDD）对个体的工作能力有负面影响，且常与长期病假相关。因此，在过去几十年中，促进MDD患者重返工作岗位的干预措施受到了越来越多的关注。我们在此报告一项可行性研究的结果，该研究将荷兰的拉格维尔德及其同事发表的一个“重返工作岗位”（RTW）模块纳入德国患有长期病假的抑郁症患者的认知行为疗法中。我们的研究旨在回答以下问题：RTW是否被患者和治疗师接受？RTW干预措施是否能导致患者重返工作岗位？抑郁症状是否会改善？
纳入20例MDD患者（15例女性；平均年龄45±9岁）。患者接受了包含标准化RTW模块的认知行为疗法（W-CBT）。心理测量指标包括贝克抑郁量表（BDI-2）和工作能力指数（WAI）。此外，还测量了重返工作岗位所需的时间，并使用视觉模拟量表和开放式问题评估了W-CBT的可接受性。
抑郁症患者的平均病假天数为127±97天，75%的患者病假超过6周。治疗后，20例患者中有11例（55%）回到了原来的工作岗位，5例（25%）进行了职业重新调配或开始了新工作，3例（2/20；10%）仍在休病假，1例（1/20；5%）领取了养老金。1例患者退出研究。BDI-2总分从23±8降至8±5（p<0.001），WAI从28±6提高到39±7（p<0.001）。患者和治疗师对W-CBT的可接受性较高。
我们在此证明了将RTW模块纳入标准认知行为疗法的可行性和可接受性。W-CBT可提高工作能力，同时改善抑郁症状。尽管这项非对照研究存在局限性，但结果表明W-CBT在治疗患有长期病假的抑郁症患者中可能是可行的，并有理由进行一项对照试验来评估W-CBT的疗效。
