Prevention of major depression and long-term sickness absence in the labour force through early intervention

Mental health problems, such as major depression, are prevalent in the labour force and are important reasons for long-term sickness absence and work disability. So far, work rehabilitation in case of absenteeism due to depression remains difficult and symptom reduction does not necessarily lead to work resumption. It is therefore hypothesized that a strategy aimed at the prevention of major depression, as well as long-term sickness absence, through an earlier treatment of mild depressive complaints will be more effective. However, such an innovative preventive strategy, including screening and subsequent early intervention, has never been investigated before. The aim of this project is to evaluate screening of employees with mild depressive complaints at high risk for long-term sickness absence and to study the effectiveness of a specific early preventive intervention in this group. The project involves a randomised controlled trial (n=180) with one experimental condition (n=1x90) and one control condition (n=1x90). The intervention involves Cognitive Behaviour Therapy (CBT). The control group receives care as usual from the occupational health service, that is, if the employee asks for help or in case of sickness absence. The study will be conducted among employees of ABN-AMRO in The Netherlands. By means of a screening device, containing the recently developed and validated Balance Meter, the Hospital Anxiety and Depression Scale and DSM IV criteria, 180 employees out of a group of 5000 respondents, will be identified as employees with depressive complaints at high risk for long-term sickness absence. Primary outcome measures are depressive symptom levels and sickness absence during a 12-month follow-up period. Screening will be evaluated through comparison of those scoring above the cut-off point of the screening device (control group) with those scoring below the cutoff point with respect to future sickness absence. Effectiveness of early preventive intervention will be evaluated through comparison of the intervention group with the control condition in terms of depression levels and future sickness absence. As such, this project will significantly contribute to the prevention of mental health problems and related sickness absence among employees.