Enhancing sense of coherence via early intervention among depressed occupational health care clients.

BACKGROUND: Research on interventions improving psychological adjustment has suggested that sense of coherence (SOC) could be improved. AIMS: In the present study, we measured the impact of an intervention on the SOC among adults with first-episode depression. We also examined whether rehabilitation, depression, occupational stressors, life situation stressors and socio-demographic characteristics are associated with a change in the SOC. METHODS: Occupational health care clients were screened for depression using the Beck Depression Inventory (BDI) and a structured clinical interview (the The Structured Clinical Interview for DSM-IV: SCID-I). The participating subjects were randomized into a rehabilitation group (n = 134) and control group (n = 100) receiving treatment as usual. The Sense of Coherence Scale (SOC-13) was used at the baseline and in a 1-year follow-up to compare the change of the SOC between the groups. RESULTS: The increase in the mean SOC score was statistically significant both in the rehabilitation group (54.91 compared with 62.85, P < 0.001) and in the control group (55.29 compared with 61.64, P < 0.001). There was no significant difference in the mean SOC scores between the groups at the follow-up. The improved SOC was associated with less severe depression (P = 0.003) and greater decreasing in BDI (P = 0.041) in the rehabilitation group. CONCLUSIONS: The results suggest that both rehabilitation and conventional depression treatment in a first episode of depression may enhance the SOC and that rehabilitation itself enhances the SOC more effectively among those with less severe depression or those whose BDI scores had further decreased at the 1-year follow-up.

The Impact of an Early Eclectic Rehabilitative Intervention on Symptoms in First Episode Depression among Employed People.

Objective. To evaluate the effect of an early vocational-orientated eclectic intervention on beck depression inventory (BDI) scores compared to treatment as usual in first ever depressive episode among employed people. Design. A randomized controlled trial comparing the rehabilitative intervention and the conventional treatment. Subjects. The subjects came from occupational health care units. Methods. Employees were sent to a rehabilitation center after being screened for depression using the BDI. They were diagnosed using the structured clinical interview for DSM-IV. The participating subjects (N = 283) were randomized into intervention and control groups. The intervention group received eclectic early depression intervention treatment (N = 134) and the control group was treated in the conventional way (N = 100). They were followed for one year. Results. The mean decrease in BDI scores within the intervention group was from 20.8 to 11.6 and within the control group from 19.3 to 10.8. BDI score decreased by 10 or more points in 64% of the participants in the intervention group and in 53% of the control group (P = 0.013). Conclusions. There was some evidence that early eclectic intervention in first ever episode depression may be more effective than conventional treatments among working age people in employment.

Obsessive-compulsive personality disorder is common among occupational health care clients with depression.

OBJECTIVE: To study how common personality disorders (PDs) are among employed subjects with first-episode depression. Depression is the single most common cause of working disability in Finland. Personality disorders are associated with depression. METHODS: Subjects were screened using the Beck Depression Inventory scale, with a cutoff point greater than 9. The structured clinical interview for Diagnostic and Statistical Manual, fourth revision, was used to assess mental disorders. Inclusion criterion was major depressive disorder. RESULTS: Most of the 272 participants were female (83%) and the majority (74%) were older than 40 years. The main finding was that one third of the participants had obsessive-compulsive PD. The prevalence of obsessive-compulsive PD was 50% among men and 28% in women. CONCLUSION: It is important to recognize comorbid PDs when assessing working-age persons experiencing depression.