Psychotherapy effectiveness for major depression: a randomized trial in a Finnish community.

BACKGROUND: The purpose of this study is to assess the relative effectiveness of Interpersonal Psychotherapy (IPT), Psychoeducative Group Therapy (PeGT), and treatment as usual (TAU) for patients with Major Depressive Disorder (MDD) in municipal psychiatric secondary care in one Finnish region. METHODS: All adult patients (N = 1515) with MDD symptoms referred to secondary care in 2004-2006 were screened. Eligible, consenting patients were assigned randomly to 10-week IPT (N = 46), PeGT (N = 42), or TAU (N = 46) treatment arms. Antidepressant pharmacotherapy among study participants was evaluated. The Hamilton Depression Rating scale (HAM-D) was the primary outcome measure. Assessment occurred at 1, 5, 3, 6, and 12 months. Actual amount of therapists' labor was also evaluated. All statistical analyses were performed with R software. RESULTS: All three treatment cells showed marked improvement at 12-month follow-up. At 3 months, 42 % in IPT, 61 % in PeGT, and 42 % in TAU showed a mean ≥50 % in HAM-D improvement; after 12 months, these values were 61 %, 76 %, and 68 %. Concomitant medication and limited sample size minimized between-treatment differences. Statistically significant differences emerged only between PeGT and TAU favoring PeGT. Secondary outcome measures (CGI-s and SOFAS) showed parallel results. CONCLUSION: All three treatments notably benefited highly comorbid MDD patients in a public sector secondary care unit. TRIAL REGISTRATION: ClinicalTrials.gov NCT02314767 (09.12.2014).

The effectiveness of physical activity monitoring and distance counseling in an occupational setting - results from a randomized controlled trial (CoAct).

BACKGROUND: Lack of physical activity (PA) is a known risk factor for many health conditions. The workplace is a setting often used to promote activity and health. We investigated the effectiveness of an intervention on PA and productivity-related outcomes in an occupational setting. METHODS: We conducted a randomized controlled trial of 12 months duration with two 1:1 allocated parallel groups of insurance company employees. Eligibility criteria included permanent employment and absence of any condition that risked the participant's health during PA. Subjects in the intervention group monitored their daily PA with an accelerometer, set goals, had access to an online service to help them track their activity levels, and received counseling via telephone or web messages for 12 months. The control group received the results of a fitness test and an information leaflet on PA at the beginning of the study. The intervention's aim was to increase PA, improve work productivity, and decrease sickness absence. Primary outcomes were PA (measured as MET minutes per week), work productivity (quantity and quality of work; QQ index), and sickness absence (SA) days at 12 months. Participants were assigned to groups using block randomization with a computer-generated scheme. The study was not blinded. RESULTS: There were 544 randomized participants, of which 521 were included in the analysis (64% female, mean age 43 years). At 12 months, there was no significant difference in physical activity levels between the intervention group (n = 264) and the control group (n = 257). The adjusted mean difference was -206 MET min/week [95% Bayesian credible interval -540 to 128; negative values favor control group]. There was also no significant difference in the QQ index (-0.5 [-4.4 to 3.3]) or SA days (0.0 [-1.2 to 0.9]). Of secondary outcomes, body weight (0.5 kg [0.0 to 1.0]) and percentage of body fat (0.6% [0.2% to 1.1%]) were slightly higher in the intervention group. An exploratory subgroup analysis revealed no subgroups in which the intervention affected physical activity. No adverse events were reported. CONCLUSIONS: The intervention was not found effective, and this study does not provide support for the effectiveness of the workplace PA intervention used here. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00994565.

Effectiveness of a targeted occupational health intervention in workers with high risk of sickness absence: baseline characteristics and adherence as effect modifying factors in a randomized controlled trial.

INTRODUCTION: In a recently published randomized controlled trial (RCT), a targeted occupational health (OH) intervention was found effective in an intention-to-treat analysis in controlling sickness absence among workers with high risk of sickness absence, compared to usual care. We performed an exploratory subgroup analysis in order to detect possible effect modifiers and mediators. METHODS: Age, gender, working status, severity of physical impairment, depression score, self-rated working ability, co-morbidity, and sickness absence characteristics in the previous 12 months were identified as potential effect modifiers (n = 382). We conducted regression analyses with the potential effect modifiers and a mediator (treatment attendance as intended) as explanatory variables. The difference of sickness absence days during the previous year and the follow-up year was the dependent variable. RESULTS: The intervention was especially effective in the subgroups of workers who were certain that they will not be able to continue working in their current job due to health-related reasons (-74 days; 95% CI -105 to -43), had co-morbidities (-22.5 days; 95% CI -35.5 to -9.5), or severe physical impairment at work (-17.5 days; 95% CI -28.5 to -6.5). A modifying effect of age, gender, working status, depressive symptoms, or prior sickness absence on the effectiveness of this OH intervention was not found. CONCLUSIONS: This targeted OH intervention seems especially suitable for workers who consider that they are no longer able to continue working due to health reasons and have high level of physical impairment or co-morbidities. The findings from these exploratory analyses should be tested in future RCTs.

The effectiveness of physical activity monitoring and distance counselling in an occupational health setting--a research protocol for a randomised controlled trial (CoAct).

BACKGROUND: The CoAct (Cocreating Activity) study is investigating a novel lifestyle intervention, aimed at the working population, with daily activity monitoring and distance counselling via telephone and secure web messages. The main purpose of this study is to evaluate the effectiveness of lifestyle counselling on the level of physical activity in an occupational health setting. The purposes include also analysing the potential effects of changes in physical activity on productivity at work and sickness absence, and healthcare costs. This article describes the design of the study and the participant flow until and including randomization. METHODS/DESIGN: CoAct is a randomised controlled trial with two arms: a control group and intervention group with daily activity monitoring and distance counselling. The intervention focuses on lifestyle modification and takes 12 months. The study population consists of volunteers from 1100 eligible employees of a Finnish insurance company. The primary outcomes of this study are change in physical activity measured in MET minutes per week, work productivity and sickness absence, and healthcare utilisation. Secondary outcomes include various physiological measures. Cost-effectiveness analysis will also be performed. The outcomes will be measured by questionnaires at baseline, after 6, 12, and 24 months, and sickness absence will be obtained from the employer's registers. DISCUSSION: No trials are yet available that have evaluated the effectiveness of daily physical activity monitoring and distance counselling in an occupational health setting over a 12 month period and no data on cost-effectiveness of such intervention are available. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00994565.

Quality of treatment and disability compensation in depression: comparison of 2 nationally representative samples with a 10-year interval in Finland.

OBJECTIVE: Depressive disorders cause substantial work impairment that can lead to disability compensation. The authors compared treatment received for depression preceding disability pension between 2 nationally representative samples with a 10-year interval. METHOD: The medical statements for 2 random samples drawn from the Finnish national disability pension registers, representing populations granted a disability pension for DSM-III-R major depression during a 12-month period from October 1993 through September 1994 (N = 277) and for ICD-10 depressive disorders (F32-F33) from October 2003 through September 2004 (N = 265) were examined. The proportions of persons receiving weekly psychotherapy, antidepressants, adequate antidepressant dosage, sequential antidepressant trials, lithium augmentation, and electroconvulsive therapy (ECT) were compared. RESULTS: No significant differences emerged between the 2 samples, except for the adequacy of antidepressant dosage. Few subjects in either of the samples (8.7% for 1993-1994 vs. 10.6% for 2003-2004, p = .45) had received weekly psychotherapy. Most had received antidepressants (87.4% vs. 85.6%, p = .55) with increasingly adequate dosage (75.6% vs. 85.0%, p = .02), but only a minority had received sequential antidepressant trials (39.5% vs. 44.5%, p = .24). Lithium augmentation and ECT were rare (1.1% vs. 1.5%, p = .66 and 4.0% vs. 1.5%, p = .08, respectively). Even in 2003-2004, over half of the subjects were granted a disability pension without sequential antidepressant trials. CONCLUSION: This nationally representative study indicates that, despite an increased antidepressant use and improved practice guidelines for depression, a considerable proportion of the people granted long-term compensation for depression seem to be suboptimally treated. Given the enormous costs of the disability, attention to the quality of treatment provided for depression is warranted before long-term disability compensations are granted.

Self-reported health problems and sickness absence in different age groups predominantly engaged in physical work.

OBJECTIVES: To study the associations between self-reported health problems and sickness absence from work. METHODS: The results of a questionnaire survey were combined with archival data of sickness absence of 1341 employees (88% males; 62% blue-collar) in the construction, service and maintenance work within one corporation in Finland. Sex, age and occupational grading were controlled as confounders. A zero-inflated negative binomial (ZINB) regression model was used in the statistical analysis of sickness absence data. RESULTS: The prevalence of self-reported health problems increased with age, from 23% in 18-30-year-olds to 54% in 55-61-year-olds. However, in those aged 18-30 years, 71% had been absent from work and in those aged 55-61 years this proportion was 53%. When health problems and occupational grading were accounted for in the ZINB model, age as such was not associated with the number of days on sick leave, but the young workers still had higher propensity for (any) sickness absence than the old. Self-rated future working ability and musculoskeletal impairment were strong determinants of sickness absence. Among those susceptible to taking sick leave, the estimated mean number of absence days increased by 14% for each rise of 1 unit of the impairment score (scale 0-10). CONCLUSIONS: Young subjects had surprisingly high probability for sickness absence although they reported better health than their older colleagues. A higher total count of absence days was found among subjects reporting health problems and poorer working ability, regardless of age, sex and occupational grade. These findings have implications for both management and the healthcare system in the prevention of work disability.

Effectiveness of a worksite exercise program with respect to perceived work ability and sick leaves among women with physical work.

OBJECTIVES: This multicentered randomized controlled trial evaluated the effect of worksite exercise intervention on perceived work ability and sick leaves. METHODS: Women (N = 260, mean age 40 years) engaged in physically demanding laundry work were individually randomized into an intervention (N = 133) or control (N = 127) group. Perceived work ability was assessed with questionnaires at 3, 8, 12, and 15 months. Sick leave information was obtained from the personnel administration. Follow-up attendance was 100% at 3 months but declined gradually to 90% by 15 months. Both the intervention and control subjects received a 30-minute feedback on their physical capacity from a physiotherapist and individual exercise prescription and counseling. The intervention subjects also participated in worksite exercise training guided by a physiotherapist. Sixty-minute sessions (N = 26) were held once a week for 8 months. About 50% of the intervention group participated in at least two-thirds of the sessions. RESULTS: According to a dichotomized work ability index, at 12 months, workers with "good" or "excellent" work ability increased more in the intervention group than in the control group (11.0%, 95% CI 0.2-21.9), as did the health-related prognosis of work ability at 8 months (8.1%, 95% CI 0.5-16.3). There were no statistically significant differences between the two groups as regards job satisfaction, work ability index (including series of questions on 7 items), or sick leaves. CONCLUSIONS: Physical activity once a week at worksites improves the perceived work ability of women with physically demanding work only slightly. Perceived work ability and sick leaves cannot be affected very positively using single-component exercise intervention. Work ability promotion may need a more multiprofessional approach.