J. Med. Internet Res. - Long-term results of a web-based guided self-help intervention for employees with depressive symptoms: randomized controlled trial.

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Resumo

CKGROUND: Depressive disorders are highly prevalent in the working population and are associated with excessive costs. The evidence for effective worker-directed interventions for employees with depressive symptoms is limited. Treating employees with depressive symptoms via the Internet before they report sick from work could be beneficial and cost saving.OBJECTIVE: In this study, we tested the effectiveness over the period of 1 year of a Web-based guided self-help intervention, called Happy@Work, for employees with depressive symptoms who were not on sick leave.METHODS: A two-arm randomized controlled trial comparing a worker-directed, Web-based, guided self-help intervention to care as usual (CAU) was carried out. We recruited employees from 6 companies via the company's Intranet and by putting up posters. The inclusion criteria were elevated depressive symptoms as measured by a score =16 on the Center for Epidemiologic Studies Depression scale (CES-D) and not being on sick leave. The intervention contained 6 lessons and consisted of problem-solving treatment and cognitive therapy. Participants were asked to submit weekly assignments via the website after completion of a lesson and they received feedback from a coach via the website. Self-report questionnaires on depressive symptoms (CES-D; primary outcome), burnout (Maslach Burnout Inventory, MBI), work performance (Health and Work Performance Questionnaire, HPQ), duration of absenteeism, and anxiety (Hospital Anxiety and Depression Scale, HADS; secondary outcomes), were completed at baseline, posttreatment, and at 6-, and 12-month follow-up. Several subgroup and per-protocol analyses were performed.RESULTS: A total of 231 employees were randomized to either the intervention group (n=116) or to CAU (n=115). Completion of assessments varied between 54%-74%. Improvement in depressive symptoms between baseline and posttreatment was shown in all participants and these effects sustained over time. However, there were no differences between the 2 groups (adjusted regression coefficient=0.46, 95% CI -2.11 to 3.03, P=.72; Cohen's d=0.05). Differences between groups were also not significant for the secondary outcomes. No subgroups were identified to show differences between the groups, nor did we find a between-group effect in the per-protocol analyses.CONCLUSIONS: This study showed that a worker-directed, Web-based, guided self-help intervention was not more effective than CAU in reducing depressive symptoms among employees with depressive symptoms who were not on sick leave over the period of 1 year. An intervention for this specific target group might not be necessary because the recovery in the CAU group was comparable to the intervention group and sustained over a 12-month period.TRIAL REGISTRATION: Nederlands Trial Register (NTR): NTR2993; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2993 (Archived by WebCite at http://www.webcitation.org/6PL9pFC0n).

Resumo Limpo

ckground depress disord high preval work popul associ excess cost evid effect workerdirect intervent employe depress symptom limit treat employe depress symptom via internet report sick work benefici cost savingobject studi test effect period year webbas guid selfhelp intervent call happywork employe depress symptom sick leavemethod twoarm random control trial compar workerdirect webbas guid selfhelp intervent care usual cau carri recruit employe compani via compani intranet put poster inclus criteria elev depress symptom measur score center epidemiolog studi depress scale cesd sick leav intervent contain lesson consist problemsolv treatment cognit therapi particip ask submit week assign via websit complet lesson receiv feedback coach via websit selfreport questionnair depress symptom cesd primari outcom burnout maslach burnout inventori mbi work perform health work perform questionnair hpq durat absente anxieti hospit anxieti depress scale had secondari outcom complet baselin posttreat month followup sever subgroup perprotocol analys performedresult total employe random either intervent group n cau n complet assess vari improv depress symptom baselin posttreat shown particip effect sustain time howev differ group adjust regress coeffici ci p cohen d differ group also signific secondari outcom subgroup identifi show differ group find betweengroup effect perprotocol analysesconclus studi show workerdirect webbas guid selfhelp intervent effect cau reduc depress symptom among employe depress symptom sick leav period year intervent specif target group might necessari recoveri cau group compar intervent group sustain month periodtri registr nederland trial regist ntr ntr httpwwwtrialregisternltrialregadminrctviewasptc archiv webcit httpwwwwebcitationorgplpfcn

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