A Cochrane review [Abstract] 1 included 11 studies with a total of 2 556 subjects. Nine were RCTs and two were cluster RCTs. Participants were recruited in primary care settings, in outpatient settings or in a community mental health centre. In eight studies, participants had a major depressive disorder. All interventions were worker-directed, no work-directed. Only one study addressed work issues using adjuvant occupational therapy. Other interventions evaluated anti-depressant medication (selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, monoamino-oxidase inhibitors), psychodynamic therapy, enhanced primary care and psychological treatment.
For medication, the combined results of three studies (n=864) showed no difference between antidepressant medication and alternative medication in their effect on days of sickness absence (SMD 0.09; 95% CI -0.05 to 0.23). In two pooled studies (n=969), the effect of enhanced primary care on days of sickness absence did not differ from usual care in the medium term (SMD -0.02; 95% CI -0.15 to 0.12). All other comparisons were based on single studies (n=6), all of which showed a lack of significant difference for sickness absence between groups, with the exception of one small study, combined psychodynamic therapy and TCAs versus TCAs alone, which favoured the combined treatment.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes), indirectness (findings regarding work disability are mainly based on sickness absence outcomes) and study quality.
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