Preventing Mid- and Later-Life Work Limitations: Community-Based Depression Care

预防中年和晚年工作限制：基于社区的抑郁症护理

• 批准号: 8318131
• 负责人: DEBRA LERNER
• 金额: $ 54.03万
• 依托单位: TUFTS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-15 至 2014-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8318131
• 关键词: Absenteeism; Absenteeism at work; Address; Age; Age-Years; Aging; Alcoholism; Behavioral; Caring; Chronic; Chronic Disease; Cognitive Therapy; Collaborations; Communities; Comorbidity; Consult; Contracts; Cost-Benefit Analysis; Data; Depression screen; Development; Diagnostic and Statistical Manual; Dysthymic Disorder; Economics; Effectiveness; Elderly; Eligibility Determination; Employee; Employee Assistance Program (Health Care); Employment; Enrollment; Exclusion; Family member; Fertility Rates; Focus Groups; Funding; Goals; Health; Health Benefit; Hour; Industry; Information Systems; Major Depressive Disorder; Manic; Measures; Medical; Mental Depression; Mental Health; Methods; Modeling; Modification; Morbidity - disease rate; Names; Occupational Health; Occupations; Online Systems; Outcome; Pensions; Performance at work; Personal Satisfaction; Phase; Pilot Projects; Procedures; Process; Productivity; Professional counselor; Psychotic Disorders; Public Health; Public Policy; Randomized; Randomized Controlled Trials; Reading; Recommendation; Recruitment Activity; Recurrence; Relative (related person); Research; Research Infrastructure; Research Support; Resources; Retirement; Safety; Sampling; Scientist; Screening procedure; Services; Severities; Social Security; Solutions; Staging; Surveys; Symptoms; Techniques; Telephone; Testing; Time; United States; Visit; Work; Workplace; base; cohort; collaborative care; coping; cost; depressive symptoms; disability; economic value; experience; follow-up; geriatric depression; improved; improved functioning; inclusion criteria; innovation; mental age; middle age; physical conditioning; prevent; productivity loss; programs; retiree; safety net; treatment as usual; trend

DESCRIPTION (provided by applicant): National demographic, economic and cultural trends are creating a need for hiring and retaining older workers. However, while many older people will prefer and/or need to work, chronic health problems occurring in mid-life or later can severely disrupt employment. This project addresses the burden of depression on workers 50 years of age or older. The long-range goal is to disseminate an innovative program to help such workers remain engaged and productive in their work. Named the Work and Health Initiative (WHI), this community-based program provides mental health and vocational services to improve functioning and reduce productivity loss. Employee Assistance Program (EAP) counselors provide WHI care. This 46-month long study, which will be conducted in collaboration with OptumHealth, has two specific aims. Aim 1 is to prepare for a randomized controlled trial (RCT) of the WHI. Aim 2 is to conduct the RCT. This RCT will compare a usual care group of 300 employees to a WHI treatment group consisting of 200 employees (who will receive up to eight telephone visits with an EAP counselor over four months). Employees will be recruited from multiple worksites served by the OptumHealth EAP. Inclusion criteria include: age e 50 years, working e 15 hours/week, current major depression and/or dysthymia and work limitations. Several exclusions will apply. Analysis of covariance techniques will test the hypothesis that relative to usual care, the WHI improves the work outcomes of depression. Surveys administered at screening, baseline and four-month follow-up will assess the primary endpoints; health-related work performance deficits (known as "presenteeism") and missed work time (absenteeism). Process of care will be evaluated using qualitative and quantitative data. A cost- benefit analysis will estimate the economic value of the WHI with data on productivity costs. Study results potentially will result in a new multi-disciplinary method for addressing a serious public health and employment issue, which is provided within EAP; an important but underused component of the community-based employee services infrastructure. PUBLIC HEALTH RELEVANCE: Middle-aged and older workers with chronic illnesses such as depression are vulnerable to a range of adverse work outcomes. However, services to help workers cope with work problems are fragmented and of limited effectiveness. The WHI has the potential to address this significant public health, employment and public policy issue.

描述（由申请人提供）：国家人口，经济和文化趋势正在创造雇用和留住老年工人的需求。然而，虽然许多老年人更愿意和/或需要工作，但中年或中年以后发生的慢性健康问题可能严重影响就业。该项目旨在解决50岁或以上工人的抑郁负担。长期目标是传播一个创新方案，帮助这些工人保持工作投入和生产力。这项以社区为基础的计划名为工作与健康倡议（WHI），提供心理健康和职业服务，以改善功能并减少生产力损失。员工援助计划（EAP）顾问提供WHI护理。这项为期46个月的研究将与OptumHealth合作进行，有两个具体目标。目的1是为WHI的随机对照试验（RCT）做准备。目的二是开展RCT。这项随机对照试验将比较一个由300名员工组成的常规护理组和一个由200名员工组成的WHI治疗组（他们将在四个月内接受EAP顾问的最多八次电话访问）。员工将从OptumHealth EAP服务的多个工作场所招聘。入选标准包括：年龄50岁，每周工作15小时，目前患有重度抑郁症和/或心境恶劣和工作限制。几个例外将适用。协方差分析技术将测试的假设，相对于常规护理，WHI改善抑郁症的工作成果。在筛选、基线和4个月随访时进行的调查将评估主要终点;与健康相关的工作表现缺陷（称为“出勤率”）和错过工作时间（缺勤率）。护理过程将使用定性和定量数据进行评估。成本效益分析将利用生产力成本数据估计WHI的经济价值。研究结果可能会导致一个新的多学科的方法来解决一个严重的公共卫生和就业问题，这是在EAP内提供;一个重要的，但未充分利用的组成部分，以社区为基础的员工服务基础设施。公共卫生相关性：患有抑郁症等慢性疾病的中老年工人容易受到一系列不利工作结果的影响。然而，帮助工人科普工作问题的服务是分散的，而且效力有限。世界卫生倡议有可能解决这一重大的公共卫生、就业和公共政策问题。

项目成果

Improving work outcomes of dysthymia (persistent depressive disorder) in an employed population.

• DOI: 10.1016/j.genhosppsych.2015.04.001
• 发表时间: 2015-07
• 期刊: General hospital psychiatry
• 影响因子: 7
• 作者: Adler DA;Lerner D;Visco ZL;Greenhill A;Chang H;Cymerman E;Azocar F;Rogers WH
• 通讯作者: Rogers WH

A randomized clinical trial of a telephone depression intervention to reduce employee presenteeism and absenteeism.

• DOI: 10.1176/appi.ps.201400350
• 发表时间: 2015-06
• 期刊: Psychiatric services (Washington, D.C.)
• 作者: Lerner D;Adler DA;Rogers WH;Chang H;Greenhill A;Cymerman E;Azocar F
• 通讯作者: Azocar F