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Background <p>Depressive disorders can negatively impact work life sustainability for affected individuals. Little is known about depression care trajectories and their association with sustainable return to work (SRTW) after long-term sick leave. This study aimed to identify depression care trajectories during the first three months of sick leave among long-term sick-listed workers with depression and investigate their associations with SRTW.</p> Methods Design <p>Nationwide cohort study using linked data from Norwegian health and population registries. Study population: All inhabitants of Norway aged 20–64 from 1 January 2009 to 1 April 2011, who were diagnosed with depression in general practice, and had reached three months consecutive sick leave (<i>n</i> = 13 624, 63.7% women). Exposure: Depression care trajectories during the first three months of initial sick leave, identified using group-based multi-trajectory modeling. Types of depression care included were general practitioner (GP) consults, GP longer consults and/or talking therapy, antidepressant medication (MED), and specialized mental healthcare. Outcome: SRTW, measured by accumulated all-cause sickness absence days during two-year follow-up after initial sick leave, with cutoffs at 0, ≤ 30, and ≤ 90&#xa0;days. Analysis: Gender stratified generalized linear models, used to investigate the associations between depression care trajectories and SRTW, adjusting for sociodemographic factors and sick leave duration.</p> Results <p>Four depression care trajectory groups were identified: <i>“GP 12&#xa0;weeks”</i> (37.2%), <i>“GP 2&#xa0;weeks”</i> (18.6%), <i>“GP &amp; MED 12&#xa0;weeks”</i> (40.0%), and <i>“Specialist, GP &amp; MED 12&#xa0;weeks”</i> (8.7%). The <i>“GP 12&#xa0;weeks”</i> group (reference) had the highest proportion attaining SRTW for both genders. Men in the “<i>GP 2&#xa0;weeks</i>” group had a 12–14% lower likelihood for SRTW compared to the reference. Women in the <i>“Specialist,GP &amp; MED 12&#xa0;weeks 12&#xa0;weeks”</i> group had a 19- 23% lower likelihood for SRTW compared to the reference.</p> Conclusion <p>The association between depression care trajectories and SRTW varies by gender. However, trajectories involving follow-up by the GP, including both standard and longer consults and/or talking therapy over 12&#xa0;weeks, showed the highest likelihood of SRTW for both genders. Enhancing GP resources could improve SRTW outcomes by allowing more frequent and longer consultations or talking therapy.</p>

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Depression care trajectories and sustainable return to work among long-term sick-listed workers: a register-based study (The Norwegian GP-DEP Study)

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  • 发表日期：

    2025年2月19日

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  • Heidi Marie Meling,
  • Valborg Baste,
  • Sabine Ruths,
  • Norman Anderssen,
  • Inger Haukenes

摘要

Background

Depressive disorders can negatively impact work life sustainability for affected individuals. Little is known about depression care trajectories and their association with sustainable return to work (SRTW) after long-term sick leave. This study aimed to identify depression care trajectories during the first three months of sick leave among long-term sick-listed workers with depression and investigate their associations with SRTW.

Methods Design

Nationwide cohort study using linked data from Norwegian health and population registries. Study population: All inhabitants of Norway aged 20–64 from 1 January 2009 to 1 April 2011, who were diagnosed with depression in general practice, and had reached three months consecutive sick leave (n = 13 624, 63.7% women). Exposure: Depression care trajectories during the first three months of initial sick leave, identified using group-based multi-trajectory modeling. Types of depression care included were general practitioner (GP) consults, GP longer consults and/or talking therapy, antidepressant medication (MED), and specialized mental healthcare. Outcome: SRTW, measured by accumulated all-cause sickness absence days during two-year follow-up after initial sick leave, with cutoffs at 0, ≤ 30, and ≤ 90 days. Analysis: Gender stratified generalized linear models, used to investigate the associations between depression care trajectories and SRTW, adjusting for sociodemographic factors and sick leave duration.

Results

Four depression care trajectory groups were identified: “GP 12 weeks” (37.2%), “GP 2 weeks” (18.6%), “GP & MED 12 weeks” (40.0%), and “Specialist, GP & MED 12 weeks” (8.7%). The “GP 12 weeks” group (reference) had the highest proportion attaining SRTW for both genders. Men in the “GP 2 weeks” group had a 12–14% lower likelihood for SRTW compared to the reference. Women in the “Specialist,GP & MED 12 weeks 12 weeks” group had a 19- 23% lower likelihood for SRTW compared to the reference.

Conclusion

The association between depression care trajectories and SRTW varies by gender. However, trajectories involving follow-up by the GP, including both standard and longer consults and/or talking therapy over 12 weeks, showed the highest likelihood of SRTW for both genders. Enhancing GP resources could improve SRTW outcomes by allowing more frequent and longer consultations or talking therapy.