Interventions to improve return to work in depressed people

Background Work disability such as sickness absence is common in people with depression. Objectives To evaluate the effectiveness of interventions aimed at reducing work disability in employees with depressive disorders. Search methods We searched CENTRAL (The Cochrane Library), MEDLINE, EMBASE, CINAHL, and PsycINFO until January 2014. Selection criteria We included randomised controlled trials (RCTs) and cluster RCTs of work‐directed and clinical interventions for depressed people that included sickness absence as an outcome. Data collection and analysis Two authors independently extracted the data and assessed trial quality. We used standardised mean differences (SMDs) with 95% confidence intervals (CIs) to pool study results in the studies we judged to be sufficiently similar. We used GRADE to rate the quality of the evidence. Main results We included 23 studies with 26 study arms, involving 5996 participants with either a major depressive disorder or a high level of depressive symptoms. We judged 14 studies to have a high risk of bias and nine to have a low risk of bias. Work‐directed interventions We identified five work‐directed interventions. There was moderate quality evidence that a work‐directed intervention added to a clinical intervention reduced sickness absence (SMD ‐0.40; 95% CI ‐0.66 to ‐0.14; 3 studies) compared to a clinical intervention alone. There was moderate quality evidence based on a single study that enhancing the clinical care in addition to regular work‐directed care was not more effective than work‐directed care alone (SMD ‐0.14; 95% CI ‐0.49 to 0.21). There was very low quality evidence based on one study that regular care by occupational physicians that was enhanced with an exposure‐based return to work program did not reduce sickness absence compared to regular care by occupational physicians (non‐significant finding: SMD 0.45; 95% CI ‐0.00 to 0.91). Clinical interventions, antidepressant medication Three studies compared the effectiveness of selective serotonin reuptake inhibitor (SSRI) to selective norepinephrine reuptake inhibitor (SNRI) medication on reducing sickness absence and yielded highly inconsistent results. Clinical interventions, psychological We found moderate quality evidence based on three studies that telephone or online cognitive behavioural therapy was more effective in reducing sick leave than usual primary or occupational care (SMD ‐0.23; 95% CI ‐0.45 to ‐0.01). Clinical interventions, psychological com