Reducing the Burden of Depression on Employment: Improving function and work

描述（由申请人提供）： PI：大卫奥斯林，医学博士标题：减少就业抑郁症的负担：改善功能和工作摘要1。目的：抑郁症是一种普遍存在的慢性疾病，经常限制在工作，家庭和社区中发挥作用的能力。在退伍军人和平民中，抑郁症与过度失业、失业、流动、缺勤和工作表现缺陷有关。在海湾战争退伍军人中，严重抑郁症和创伤后应激障碍是100%获得与服务有关的残疾福利的主要原因。在OEF/OIF退伍军人中，患有抑郁症的人在工作中的表现缺陷和缺勤率是平民中抑郁症雇员的四倍。至少，抑郁症使这个国家每年损失240亿美元的生产力。 本研究的目的是帮助就业的退伍军人抑郁症充分参与劳动力市场，有两个目标：测试一个新的基于证据的，以职业为重点的电话咨询计划的有效性，为就业的退伍军人抑郁症，退伍军人-工作和健康倡议（V-WHI），这是由本研究的研究合作伙伴从塔夫茨医学中心; 2）如果V-WHI是有效的，则量化其投资回报率（ROI）。V-WHI将为退伍军人提供八次电话咨询会议，以解决工作中有效功能表现的障碍。这项研究将测试V-WHI与VA的抑郁症综合护理（IC）计划相结合的影响。 V-WHI基于两个科学文献机构。首先，临床研究表明，提供基于证据的抑郁症诊断和治疗有助于但不足以减少抑郁症的负性就业和相关功能缺陷。其次，对残疾（特别是工作残疾）的研究表明， 通过改善抑郁症患者与其工作环境之间的“契合度”。因此，结合VA的IC服务，这反映了VA/DOD抑郁症指南的初级保健，V-WHI的功能改善干预措施，预计将改善退伍军人的结果。2.研究设计：一项随机对照试验（RCT）将检验这样一个假设，即在IC中加入V-WHI将上级单独的IC服务。主要终点是基于经验证的工作限制问卷（WLQ）的工作表现和生产力评分的前/后变化。次要终点包括抑郁症状严重程度的变化（用经验证的PHQ-9测量）和医疗保健利用率和成本。3.方法学：在合格性筛选和知情同意后，受试者将被分配到联合项目组或仅IC组。最初，将招募250名患有抑郁症和工作限制的退伍军人（每组一半）。将在基线、第四至五个月（干预后）和第九个月进行测试。ROI分析将评估成本和收益。这项研究将通过推进功能改善的科学和实践，使退伍军人事务部和退伍军人受益。

DESCRIPTION (provided by applicant): PI: David Oslin, MD Title: Reducing the Burden of Depression on Employment: Improving Function and Work Abstract 1. Objective(s): Depression is a prevalent, often chronic condition that frequently limits ability to function at work, at home and in the community. In veteran and civilian populations, depression has been associated with excess unemployment, job loss, turnover, work absences and at-work performance deficits. Among Gulf War veterans, major depression and PTSD are leading reasons for service-connected disability benefits granted at the 100% level. Among OEF/OIF veterans with depression who are employed, at-work performance deficits and absences are four times higher than rates for depressed employees in the civilian population. At minimum, depression costs this nation $24 billion annually in lost productivity. With the goal of helping employed veterans with depression to participate fully in the labor market, this study has two objectives: test the effectiveness of a new evidence-based, vocationally-focused telephonic counseling program for employed veterans with depression, the Veterans -Work and Health Initiative (V-WHI), which was developed by this study's research partners from the Tufts Medical Center; and 2) if the V-WHI is effective, quantify its return on investment (ROI). The V-WHI will provide veterans with eight telephone counseling sessions to address barriers to effective functional performance at work. This study will test the impact of the V-WHI in combination with the VA's program of Integrated Care (IC) for depression. The V-WHI is based on two bodies of scientific literature. First, clinical research indicates that providng evidence-based depression diagnosis and treatment is helpful but not sufficient to reduce depression's negative employment and related functional deficits. Second, research on disability (and work disability specifically) suggests the potential benefits to both functioning and recovery by improving the "fit" between the employed person with depression and his or her work context. Thus, used in combination with the VA's IC services, which reflect VA/DOD Depression Guidelines for primary care, the V-WHI's functional improvement interventions are expected to improve veteran outcomes. 2. Research Design: A randomized controlled trial (RCT) will test the hypothesis that the V- WHI added to the IC will be superior to IC services alone. The primary endpoints are pre/post changes in at-work performance and productivity scores based on the validated Work Limitation Questionnaire (WLQ). Secondary endpoints include changes in depression symptom severity (measured with the validated PHQ-9) and healthcare utilization and costs. 3. Methodology: After eligibility screening and informed consent, subjects will be assigned to a combined program or IC only group. Initially, 250 employed veterans with depression and work limitations will be enrolled (half per group). Questionnaires will be administered at baseline, month four to five (post-intervention) and month nine. An ROI analysis will assess costs and benefits. This study will potentially benefit the VA and veterans by advancing the science and practice of functional improvement.