Telephone Cognitive-Behavioral Therapy for Subthreshold Depression and Presenteeism in Workplace: A Randomized Controlled Trial

Abstract

BackgroundSubthreshold 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).MethodsWe 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.ResultsThe 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).ConclusionRemote 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.Trial RegistrationClinicalTrials.gov NCT00885014

Effectiveness of a Web-Based Cognitive Behavioural Intervention for Subthreshold Depression: Pragmatic Randomised Controlled Trial

“…Most of the studies included in the meta-analysis evaluated the effectiveness of a psychological intervention in older adults and pregnant women, respectively [50,51] . Those studies including an adult population (18-65 years) showed similar effect sizes as those found in the present trial, ranging from d = 0.69 to d = 0.80 [52,53] . The observed within-group effect size in the intervention group (d = 1.06, 95% CI: 0.86-1.27) is also comparable to the pre-to post-improvement effect size in the only published study on an Internet-based treatment for sD in adults aged 50 and older (d = 1.00) [19] .…”

Behavioral activation can normalize neural hypoactivation in subthreshold depression during a monetary incentive delay task

“…The BA program used in this study was originally revised for university students, based on a CBT program for adults with subthreshold depression developed in a previous study by Furukawa et al (2012).…”

Telephone and In-Person Cognitive Behavioral Therapy for Major Depression after Traumatic Brain Injury: A Randomized Controlled Trial

“…68,69 Although originally developed for Englishspeaking primary care patients, the program has been adapted for different populations and translated into multiple languages. [70][71][72][73][74] Based on our prior TBI telephone counseling studies, 59,75 the intervention protocol was tailored in several ways to individuals living with TBI. Brief care management at the beginning of each session addressed issues specific to promoting TBI rehabilitation and recovery, 76 including return to work or school, substance abuse, social and interpersonal isolation, and transportation difficulties.…”