| Citation: |
Schene, A, Koeter, M., Kikkert, M., Swinkels, J., & Crone, P. (2007). Adjuvant occupational therapy for work-related
major depression works: randomized trial including
economic evaluation.
Psychological Medicine, 37
(3),
351-362.
|
| Title: |
Adjuvant occupational therapy for work-related
major depression works: randomized trial including
economic evaluation |
| Authors: |
Schene, A, Koeter, M., Kikkert, M., Swinkels, J., & Crone, P. |
| Year: |
2007 |
|
Journal/Publication:
|
Psychological Medicine |
| Publisher: |
Cambridge Press |
| DOI: |
https://doi.org/10.1017/S0033291706009366
|
| Full text: |
http://proxy.library.vcu.edu/login?url=http://journals.cambridge.or...
|
| Peer-reviewed? |
Yes
|
| NIDILRR-funded? |
No
|
|
Research design:
|
Randomized controlled trial
|
| Background: |
Major depression has far-reaching consequences for work functioning and absenteeism. In most cases depression is treated by medication and clinical management. The addition of occupational therapy (OT) might improve outcome. |
|
Purpose:
|
The purpose of the study was to determine the cost-effectiveness of the
addition of OT to treatment as usual (TAU). |
|
Setting:
|
Study was conducted as part of the Programme for Mood Disorders of the Department of Psychiatry on the Academic Medical Centre in Amsterdam. |
|
Study sample: |
The study sample included 62 adults. The inclusion criteria were: age above 18 years, major depressive disorder, single episode or recurrent, without psychotic features, no history of psychos, manic, hypo-manic or cyclothymic features, no history of alcohol abuse or dependence, and additional criteria. |
|
Intervention:
|
Sixty-two adults with major depression and a mean absenteeism of 242 days were
randomized to TAU (out-patient psychiatric treatment) or TAU plus OT [6 months, including (i) diagnostic phase with occupational history and work reintegration plan, and (ii) therapeutic phase with individual sessions and group sessions]. Main outcome domains were depression, work resumption, work stress and costs. Assessments were at baseline and at 3, 6, 12 and 42 months. |
|
Control or comparison condition:
|
Treatment as usual was the standard out- patient treatment for depression. This consisted of clinical management and antidepressants, if indicated and accepted by patients, according to standard treatment algoruthm. |
|
Data collection and analysis:
|
Treatment effect of OT was tested using the t test for continuous measures and the chi-squared test for categorical variables. For longitudinal analysis, the generalized estimating equations method for dichotomous outcomes and a generalized linear model approach for continuous outcomes was used. |
|
Findings:
|
The addition of OT to TAU: (i) did not improve depression outcome, (ii) resulted in a reduction in work-loss days during the first 18 months, (iii) did not increase work stress, and
(iv) had a 75.5% probability of being more cost-effective than TAU alone. |
|
Conclusions:
|
Addition of OT to good clinical practice does not improve depression outcome, improves productivity without increasing work stress and is superior to TAU in terms of cost-effectiveness |
