Collaborative care for sick-listed employees with Major Depressive Disorder: outcomes of a randomized clinical trial.
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Background: Major Depressive Disorder (MDD) has significant consequences for employees as well as for society as a whole. Although evidence-based treatment modes for depression are available in current usual care, its prevalence is not decreasing in the Netherlands. Collaborative care – an integrated care model – may be a solution. The current study evaluates the effectiveness of collaborative care for sick-listed employees with MDD. Methods: A number of 126 employees who were sick listed between 4 and 12 weeks were included. Data was measured by questionnaires at baseline and at 3, 6, 9 and 12 months after baseline. Depressive symptoms are measured with the PHQ9, defined as the outcome parameters remission, response and reduction of symptoms (continuous outcome measure). Using multilevel analyses, these parameters are compared between the collaborative care group (CC-group) and the group of employees who received care as usual (CAU-group). Results: Although the severity of depressive symptoms reduced at 3, 6, 9 and 12 months compared to baseline, there were no significant differences in depression between the CC- and CAU-group with the exception of a higher response rate in the CC-group at 3 months. Additional analyses showed that collaborative care was more effective in the reduction of symptoms at 3 months within the sub-group of employees with a baseline PHQ-9 score of 15 or higher. Conclusion: Collaborative care in the occupational health care setting does not lead to better long-term results in the reduction of symptoms than care as usual. However, it does lead to reduced participation in more expensive intensive outpatient treatment.