Hange Dominique, Ariai Nashmil, Björkelund Cecilia, Svenningsson Irene, Nejati Shabnam, Petersson Eva-Lisa, Augustsson Pia, Skoglund Ingmarie
Primary Health Care/School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden.
Heliyon. 2021 May 28;7(5):e07116. doi: 10.1016/j.heliyon.2021.e07116. eCollection 2021 May.
BACKGROUND: An increasing number of patients are on sick leave because of common mental disorders (CMD), with or without antidepressant therapy. There is a lack of long-term follow-up studies in the primary care context, where most of the patients are treated. The importance of identifying potential factors associated with work ability for CMD patients is increasingly in focus. OBJECTIVE: To investigate the associations between using antidepressants, sick leave duration, reported work ability and psychological symptoms among patients with CMD during a two-year observation period in the primary care context. METHODS: Longitudinal observational cohort study at 28 Primary Care Centers in Region Västra Götaland, Sweden, including 182 patients with an employment and on sick leave for CMD. The following outcomes were assessed: work ability measured with WAI, depressive symptoms with MADRS-S, anxiety symptoms with BAI, fatigue symptoms with KEDS, quality of life with EQ-5D, and days of sick leave. The data were compared between the groups that used and did not use antidepressants, during the 24-months observation period. RESULTS: Work ability and health-related quality of life increased over time in both groups. A steeper decrease of depressive symptoms, anxiety symptoms as well as an increased health-related quality of life at 3, 6 and 12 months was found in the group without antidepressants, although both groups levelled off at 24 months. In both groups, a higher work ability at baseline was associated with less two-year sick leave. CONCLUSION: Our study indicates that a high work ability at baseline has a strong association with a lower total net and gross sick leave duration during the entire two-year follow-up period for patients with CMD in primary health care, irrespective of use of antidepressants. Using WAI in primary health care could therefore be helpful in predicting return to work. Use of antidepressants during the CMD episode could indicate initially a more pronounced overall symptom pattern, motivating introduction of antidepressants, rather than prolonging the sick leave period.
背景：越来越多的患者因常见精神障碍（CMD）而休病假，无论是否接受抗抑郁治疗。在大多数患者接受治疗的初级保健环境中，缺乏长期随访研究。识别与CMD患者工作能力相关的潜在因素的重要性日益受到关注。 目的：在初级保健环境中，调查CMD患者在两年观察期内使用抗抑郁药、病假时长、报告的工作能力和心理症状之间的关联。 方法：在瑞典西约塔兰地区的28个初级保健中心进行纵向观察队列研究，纳入182名因CMD而就业且休病假的患者。评估以下结果：用工作能力指数（WAI）测量工作能力，用蒙哥马利-艾森伯格抑郁量表-自我报告版（MADRS-S）测量抑郁症状，用贝克焦虑量表（BAI）测量焦虑症状，用疲劳量表（KEDS）测量疲劳症状，用欧洲五维度健康量表（EQ-5D）测量生活质量，以及病假天数。在24个月的观察期内，对使用和未使用抗抑郁药的两组数据进行比较。 结果：两组的工作能力和与健康相关的生活质量均随时间提高。未使用抗抑郁药的组在3个月、6个月和12个月时抑郁症状、焦虑症状下降更为明显，且与健康相关的生活质量提高，尽管两组在24个月时趋于平稳。在两组中，基线时较高的工作能力与两年病假较少相关。 结论：我们的研究表明，在初级卫生保健中，对于CMD患者，无论是否使用抗抑郁药，基线时较高的工作能力与整个两年随访期内较低的总净病假时长和总病假时长密切相关。因此，在初级卫生保健中使用WAI可能有助于预测重返工作岗位。在CMD发作期间使用抗抑郁药最初可能表明总体症状模式更明显，这促使使用抗抑郁药，而不是延长病假时间。
Soc Psychiatry Psychiatr Epidemiol. 2017-10
Scand J Public Health. 2017-6
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