Indicated Prevention Interventions in the Workplace for Depressive Symptoms: A Systematic Review and Meta-analysis.

CONTEXT: Depressive symptoms are highly prevalent and cause substantive morbidities and loss of functioning among employees. Depression may be prevented at its early stages. However, there is a paucity of information regarding indicated preventive interventions for depression among employees. The objective of this review is to examine the effectiveness of indicated interventions for the reduction of depressive symptoms in the workplace. EVIDENCE ACQUISITION: A systematic review and meta-analysis of articles published between January 2000 and September 2017 was conducted using major electronic databases, including PubMed/MEDLINE, PsycINFO, EMBASE, SOCINDEX, and ABI/ProQuest. Studies were selected based on a set of predefined inclusion criteria. Primary outcome measures were depressive symptomatology, and the interventions were preventive in nature. Studies were pooled based on the intervention type and the effect size was measured using the standardized mean difference. EVIDENCE SYNTHESIS: A computer and hand search of the literature yielded 4,462 papers, from which 16 trials were identified to be suitable for meta-analysis. Eight of 16 studies reported significant effects for workplace preventive interventions targeting depressive symptoms in which six were cognitive behavioral therapy (CBT)-based interventions and two were non-CBT-based interventions. Small to medium effect sizes were found for both CBT- and non-CBT-based interventions (standardized mean difference= -0.44, 95% CI= -0.61, -0.26, I2=62.1% and standardized mean difference= -0.32, 95% CI= -0.59, -0.06, I2=58%, respectively). CONCLUSIONS: This review demonstrates that indicated interventions can significantly reduce the level of depressive symptoms among workers. The implementation of evidence-based workplace interventions should consequently be considered to prevent the development of depressive symptoms among employees.

Exploring the Experiences of Persons Who Frequently Visit the Emergency Department for Mental Health-Related Reasons.

In this qualitative study, the experiences of persons who frequently visit the emergency department (ED) for mental health-related reasons were explored. Interpretive Description guided the design, and data were collected through interviews with 10 adults who made 12+ ED visits within a 1-year time frame (2015). Thematic analysis was used to analyze data inductively. The participants' experiences were described with the help of three themes emerging from the data: The Experience, The Providers, and Protective Factors. The participants felt compelled to come to hospital. For them, every visit was necessary, and dismissal of their needs by staff was interpreted as disrespect and prejudice. We noted differences in ED utilization patterns according to psychiatric diagnosis, and more research is needed to explore the phenomenon of frequent use by particular patient populations. Furthermore, health care providers implementing interventions designed to improve emergency care should consider tailored approaches rather than a one-size-fits-all strategy.

Prognostic factors for return to work of employees with common mental disorders: a meta-analysis of cohort studies.

PURPOSE: To examine prognostic factors for return to work (RTW) of employees with common mental disorders (CMDs). METHODS: A systematic review and meta-analysis were performed using data from 18 published cohort studies with 24,579 participants. The studies were identified from MEDLINE/PubMed, PsycINFO, EMBASE, SocINDEX, and Human resource management databases from 1995 to 2016. Two authors independently screened selected studies and assessed the quality of the studies as well as the extracted data. RESULTS: We screened 7755 abstracts, from which 211 full text articles were reviewed. Eighteen cohort studies met the inclusion criteria and were included in the analysis. Significant prognostic factors for RTW included age, contact with medical specialists, RTW-self-efficacy, and work ability. The pooled hazard ratios and 95% confidence interval (CI) for age, RTW-SE, contact with medical specialists, and high work ability/low work demands in relation to RTW were 0.77 (95% CI 0.65-0.88), 1.79 (95% CI 1.24-2.33), 0.64 (95% CI 0.49-0.80) and 1.08 (95% CI 1.06-1.11), respectively. CONCLUSIONS: Self-efficacy (SE) is a key factor in the enhancement of work ability and RTW. Improving employee's SE and collaborating with employers to enhance work ability may help to facilitate RTW. As the RTW process is complex, exploring theoretical frameworks for RTW in individuals with a CMD is also needed.