Telephone cognitive-behavioral therapy for subthreshold depression and presenteeism in workplace: a randomized controlled trial

• Published in: PloS one Vol. 7; no. 4; p. e35330
• Main Authors: Furukawa, Toshi A, Horikoshi, Masaru, Kawakami, Norito, Kadota, Masayo, Sasaki, Megumi, Sekiya, Yuki, Hosogoshi, Hiroki, Kashimura, Masami, Asano, Kenichi, Terashima, Hitomi, Iwasa, Kazunori, Nagasaku, Minoru, Grothaus, Louis C
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 19.04.2012; Public Library of Science (PLoS)
• Subjects: Absenteeism; Adult; Antidepressants; Behavior modification; Behavior therapy; Behavioral medicine; Care and treatment; Clinical trials; Cognitive ability; Cognitive Therapy - methods; Cognitive-behavioral therapy; Depression (Mood disorder); Depression - psychology; Depression - therapy; Depressive Disorder - psychology; Depressive Disorder - therapy; Education; Efficiency; Employee assistance programs; Female; Follow-Up Studies; Health psychology; Humans; Intervention; Japan; Male; Medical screening; Medicine; Mental depression; Mental disorders; Mental health; Middle Aged; Occupational health; Occupational stress; Primary care; Productivity; Psychiatric Status Rating Scales; Psychiatry; Psychotherapy; Public health; Quality assurance; Randomization; Remote Consultation - methods; Severity of Illness Index; Social and Behavioral Sciences; Statistical analysis; Stress; Studies; Telephone; Treatment Outcome; University graduates; Workplace - psychology; Japan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0035330

Subthreshold depression is highly prevalent in the general population and causes great loss to society especially in the form of reduced productivity while at work (presenteeism). We developed a highly-structured manualized eight-session cognitive-behavioral program with a focus on subthreshold depression in the workplace and to be administered via telephone by trained psychotherapists (tCBT). We conducted a parallel-group, non-blinded randomized controlled trial of tCBT in addition to the pre-existing Employee Assistance Program (EAP) versus EAP alone among workers with subthreshold depression at a large manufacturing company in Japan. The primary outcomes were depression severity as measured with Beck Depression Inventory-II (BDI-II) and presenteeism as measured with World Health Organization Health and Work Productivity Questionnaire (HPQ). In the course of the trial the follow-up period was shortened in order to increase acceptability of the study. The planned sample size was 108 per arm but the trial was stopped early due to low accrual. Altogether 118 subjects were randomized to tCBT+EAP (n = 58) and to EAP alone (n = 60). The BDI-II scores fell from the mean of 17.3 at baseline to 11.0 in the intervention group and to 15.7 in the control group after 4 months (p<0.001, Effect size = 0.69, 95%CI: 0.32 to 1.05). However, there was no statistically significant decrease in absolute and relative presenteeism (p = 0.44, ES = 0.15, -0.21 to 0.52, and p = 0.50, ES = 0.02, -0.34 to 0.39, respectively). Remote CBT, including tCBT, may provide easy access to quality-assured effective psychotherapy for people in the work force who present with subthreshold depression. Further studies are needed to evaluate the effectiveness of this approach in longer terms. The study was funded by Sekisui Chemicals Co. Ltd. ClinicalTrials.gov NCT00885014.