The Cochrane review «Nieuwenhuijsen K, Faber B, Verbeek JH ym. Interven...»1 aimed so evaluate the effectiveness of interventions aimed at reducing work disability in employees with depressive disorders. Randomised controlled trials (RCTs) and cluster RCTs of work-directed and clinical interventions for depressed people that included sickness absence as an outcome were included. The analyses were based on 23 studies with 26 study arms, involving 5996 participants with either a major depressive disorder or a high level of depressive symptoms. Altogether 14 studies were judged to have a high risk of bias and nine to have a low risk of bias.
Five work-directed interventions were identified. There was moderate quality evidence that a work-directed intervention added to a clinical intervention reduced sickness absence (SMD -0.40; 95 % CI -0.66 to -0.14; 3 studies) compared to a clinical intervention alone.
There was moderate quality evidence based on a single study that enhancing the clinical care in addition to regular work-directed care was not more effective than work-directed care alone (SMD -0.14; 95 % CI -0.49 to 0.21).
There was very low quality evidence based on one study that regular care by occupational physicians that was enhanced with an exposure-based return to work program did not reduce sickness absence compared to regular care by occupational physicians (non-significant finding: SMD 0.45; 95 % CI -0.00 to 0.91).
There was moderate quality evidence based on three studies that telephone or online cognitive behavioural therapy was more effective in reducing sick leave than usual primary or occupational care (SMD -0.23; 95 % CI -0.45 to -0.01).
There was low quality evidence based on two studies that enhanced primary care did not substantially decrease sickness absence in the medium term (4 to 12 months) (SMD -0.02; 95 % CI -0.15 to 0.12). A third study found no substantial effect on sickness absence in favour of this intervention in the long term (24 months).
There was high quality evidence, based on one study, that a structured telephone outreach and care management program was more effective in reducing sickness absence than usual care (SMD - 0.21; 95 % CI -0.37 to -0.05).
We found low quality evidence based on one study that supervised strength exercise reduced sickness absence compared to relaxation (SMD -1.11; 95 % CI -1.68 to -0.54). We found moderate quality evidence based on two studies that aerobic exercise was no more effective in reducing sickness absence than relaxation or stretching (SMD -0.06; 95 % CI -0.36 to 0.24).