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

描述（由申请人提供）：国家人口，经济和文化趋势正在创造雇佣和留住老年工人的需求。然而，尽管许多老年人更愿意和/或需要工作，但中年或老年出现的慢性健康问题会严重扰乱就业。该项目旨在解决50岁以上工人的抑郁负担。长期目标是传播一项创新计划，帮助这些工人在工作中保持投入和生产力。这个以社区为基础的项目名为“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）辅导员提供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。目的二是进行随机对照试验。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4个月内接受多达8次EAP咨询师的电话访问）。员工将从OptumHealth EAP服务的多个工作场所招聘。纳入标准包括：年龄50岁，每周工作15小时，目前患有严重抑郁症和/或心境恶劣，工作受限。一些例外情况将适用。协方差分析技术将检验假设，相对于常规护理，WHI改善抑郁症的工作结果。在筛查、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”）和错过工作时间（旷工）。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的数据来估计WHI的经济价值。研究结果可能会产生一种新的多学科方法来解决严重的公共卫生和就业问题，这是在环境援助计划内提供的；基于社区的雇员服务基础设施的重要但未充分利用的组成部分。公共卫生相关性：患有抑郁症等慢性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，帮助工人解决工作问题的服务是分散的，效率有限。卫生倡议有潜力解决这一重大的公共卫生、就业和公共政策问题。

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.