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

描述(由申请人提供)： PI：David Oslin，医学博士标题：减轻抑郁症对就业的负担：改善功能和工作摘要1.目的：抑郁症是一种普遍的、通常是慢性的疾病，经常限制在工作、家庭和社区中的功能能力。在退伍军人和平民人口中，抑郁症与过度失业、失业、流动率、缺勤和工作表现不足有关。在海湾战争退伍军人中，严重的抑郁症和创伤后应激障碍是100%获得与服务相关的残疾福利的主要原因。在有工作的患有抑郁症的OEF/OIF退伍军人中，工作表现缺陷和缺勤率是平民人口中抑郁员工的四倍。至少，经济萧条每年给美国造成240亿美元的生产力损失。为了帮助患有抑郁症的退伍军人充分参与劳动力市场，这项研究有两个目标：测试由塔夫茨医学中心的研究伙伴开发的针对患有抑郁症的退伍军人的新的基于证据的、以职业为重点的电话咨询计划-退伍军人-工作和健康倡议(V-WHI)的有效性；以及2)如果V-WHI有效，则量化其投资回报(ROI)。V-WHI将为退伍军人提供8次电话咨询，以解决在工作中有效发挥职能的障碍。这项研究将测试V-WHI与退伍军人管理局的抑郁症综合护理(IC)计划相结合的影响。V-WHI基于两组科学文献。首先，临床研究表明，提供循证抑郁症诊断和治疗是有帮助的，但不足以减少抑郁症的负面就业和相关的功能缺陷。其次，对残疾(特别是工作残疾)的研究表明，残疾对功能和康复都有潜在的好处 通过改善受雇抑郁症患者与其工作环境之间的“契合度”。因此，与退伍军人管理局反映退伍军人事务部/国防部初级保健指南的IC服务相结合，V-WHI的功能改善干预有望改善退伍军人的结果。2.研究设计：一项随机对照试验(RCT)将检验这样一种假设，即添加到IC中的V-WHI将优于单独的IC服务。主要终点是基于经过验证的工作限制问卷(WLQ)的工作绩效和工作效率分数在工作前后的变化。次要终端包括抑郁症症状严重程度(使用经过验证的PHQ-9衡量)以及医疗保健利用率和成本的变化。3.方法：经过资格筛选和知情同意后，受试者将被分配到一个联合计划组或仅限IC组。最初，将招募250名有抑郁症和工作限制的受雇退伍军人(每组一半)。问卷将在基线、4至5个月(干预后)和9个月进行。投资回报分析将评估成本和收益。这项研究将通过促进功能改善的科学和实践，潜在地使退伍军人和退伍军人受益。

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.