Longitudinal relationship between depressive symptoms and work outcomes in clinically treated patients with long-term sickness absence related to major depressive disorder.

Background: Major depressive disorder (MDD) negatively affects a wide range of work outcomes (absenteeism, work productivity, work limitations). However, the exact longitudinal relationship between depressive symptoms and work outcomes in MDD patients with long-term sickness absence is still unclear. Therefore, the present study aimed to examine the temporal and directional relationship between depressive symptoms and various work outcomes in these patients.

Methods: Patients (n = 117) were diagnosed with MDD according to DSM-IV criteria, had a median duration of MDD-related sickness absence of 4.8 months (IQR = 2.6-10.1 months) at baseline, and were referred by occupational physicians. All patients received outpatient treatment for their MDD. Depressive symptoms and work outcomes were examined during baseline, and 6-, 12- and 18-month follow-ups.

Results: Within-subject changes in the severity of depressive symptoms were significantly related to within-subject changes in all work outcomes (all scales: p < 0.001). Earlier reduction in depressive symptoms predicted subsequent improvements in all work outcomes (all scales: p < 0.05). Conversely, only earlier improvement in Time Management (p = 0.007) and Mental/Interpersonal (p < 0.001) work limitations predicted a subsequent reduction in depressive symptoms.

Limitations: All work outcomes were assessed through self-report. Work limitations at the start of absenteeism were retrospectively assessed.

Conclusions: Symptom reduction remains crucial for improving adverse work outcomes in MDD patients with long-term sickness absence. In addition, a treatment focus on qualitative functioning in the workplace may accelerate depression recovery.