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

减轻抑郁症对就业的负担：改善功能和工作

• 批准号: 8677026
• 负责人: DAVID W. OSLIN
• 金额: --
• 依托单位: PHILADELPHIA VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-05-01 至 2018-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8677026
• 关键词: Absenteeism; Address; Aftercare; Caring; Chronic; Clinical Research; Communities; Consent; Cost Savings; Costs and Benefits; Counseling; Data; Depressed mood; Depressive disorder; Diagnosis; Diagnostic and Statistical Manual of Mental Disorders; Disease; Economics; Effectiveness; Eligibility Determination; Employee; Employment; Enrollment; Family; Goals; Grant; Guidelines; Gulf War; Health; Health Care Costs; Health Services Research; Home environment; Hour; Human; Informed Consent; Intervention; Investments; Literature; Major Depressive Disorder; Marketing; Measures; Medical center; Mental Depression; Mental Health; Mental Health Services; Methodology; Modeling; Names; Occupations; Outcome; Outcome Measure; Participant; Performance at work; Persons; Population; Post-Traumatic Stress Disorders; Prevention; Primary Health Care; Productivity; Professional counselor; Questionnaires; Randomized Controlled Trials; Recovery of Function; Rehabilitation therapy; Relative (related person); Reporting; Research; Research Design; SF-12; Science; Services; Severities; Symptoms; Telephone; Testing; Time; Unemployment; United States Department of Veterans Affairs; Veterans; Vulnerable Populations; Work; Workplace; abstracting; base; clinical Diagnosis; cost; cost effective; depressive symptoms; disability; evidence base; experience; follow-up; functional improvement; health care service utilization; health related quality of life; improved; improved functioning; innovation; post intervention; productivity loss; programs; psychologic; public health relevance; research study; screening; therapy design; treatment as usual

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.

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. 目标：抑郁症是一种普遍存在的慢性疾病，经常限制工作、家庭和工作的能力社区。在退伍军人和平民中，抑郁症与过度失业、失业、人员流动、缺勤和工作绩效缺陷有关。在海湾战争退伍军人中，重度抑郁症和创伤后应激障碍 (PTSD) 是 100% 授予与服役相关的残疾福利的主要原因。在受雇的 OEF/OIF 患有抑郁症的退伍军人中，工作表现缺陷和缺勤率比平民中患有抑郁症的员工高出四倍。至少，抑郁症每年给这个国家造成 240 亿美元的生产力损失。 为了帮助患有抑郁症的就业退伍军人充分参与劳动力市场，本研究有两个目标：测试针对患有抑郁症的就业退伍军人的新的循证、以职业为重点的电话咨询计划的有效性，退伍军人工作和健康倡议 (V-WHI)，由本研究的塔夫茨医学中心研究合作伙伴制定； 2) 如果 V-WHI 有效，则量化其投资回报 (ROI)。 V-WHI 将为退伍军人提供八次电话咨询课程，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 VA 抑郁症综合护理 (IC) 计划相结合的影响。 V-WHI 基于两部分科学文献。首先，临床研究表明，提供循证抑郁症诊断和治疗对于减少抑郁症的消极就业和相关功能缺陷有帮助，但不足以减少。其次，对残疾（特别是工作残疾）的研究表明，它对功能和恢复都有潜在的好处 改善抑郁症雇员与其工作环境之间的“契合度”。因此，V-WHI 的功能改善干预措施与 VA 的 IC 服务（反映 VA/DOD 抑郁症初级保健指南）结合使用，预计将改善退伍军人的治疗结果。 2. 研究设计：随机对照试验 (RCT) 将检验以下假设：添加到 IC 中的 V-WHI 将优于单独使用 IC 服务。主要终点是基于经过验证的工作限制问卷 (WLQ) 的工作绩效和生产力分数的前后变化。次要终点包括抑郁症状严重程度的变化（使用经过验证的 PHQ-9 测量）以及医疗保健利用率和成本。 3. 方法：在资格筛选和知情同意后，受试者将被分配到联合计划组或仅 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）。调查问卷将在基线、第四至第五个月（干预后）和第九个月进行。投资回报率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来使退伍军人管理局和退伍军人受益。