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Adjuvant occupational therapy improves long-term depression recovery and return-to-work in good health in sick-listed employees with major depression: results of a randomised controlled trial
  1. Hiske L Hees,
  2. Gabe de Vries,
  3. Maarten W J Koeter,
  4. Aart H Schene
  1. Program for Mood Disorders, Department of Psychiatry, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to Hiske Leona Hees, Program for Mood Disorders, Department of Psychiatry, Academic Medical Center (AMC), University of Amsterdam, Meibergdreef 5, Amsterdam 1105 AZ, The Netherlands; H.L.Hees{at}


Objectives To evaluate whether adjuvant occupational therapy (OT) can improve the effectiveness of treatment-as-usual (TAU) in sick-listed employees with major depression.

Methods In total, 117 employees sick-listed for a median duration of 4.8 months (IQR=2.6 to 10.1 months) because of major depression were randomised to TAU (n=39) or adjuvant OT (TAU+OT; n=78). OT (18 sessions) focussed on a fast return to work (RTW) and improving work-related coping and self-efficacy. The primary outcome was work participation (hours of absenteeism+duration until partial/full RTW). Secondary outcomes were depression, at-work functioning, and health-related functioning. Intermediate outcomes were work-related, coping and self-efficacy. Blinded assessments occurred at baseline and 6, 12 and 18 months follow-up.

Results The groups did not significantly differ in their overall work participation (adjusted group difference=−1.9, 95% CI −19.9 to +16.2). However, those in TAU+OT did show greater improvement in depression symptoms (−2.8, −5.5 to −0.2), an increased probability of long-term symptom remission (+18%, +7% to +30%), and increased probability of long-term RTW in good health (GH) (+24%, 12% to 36%). There were no significant group differences in the remaining secondary/intermediate outcomes.

Conclusions In a highly impaired population, we could not demonstrate significant benefit of adjuvant OT for improving overall work participation. However, adjuvant OT did increase long-term depression recovery and long-term RTW in GH (ie, full RTW while being remitted, and with better work and role functioning).

Trial Registration Dutch Trial Register NTR2057.

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