Abstract
Objectives: With the abrupt increase of depression patients, it is strongly requested to support them returning to work smoothly. Therefore various treatment programs have begun to be practiced in some institutions in our country. However, they are not unified, and it is made through trial and error in each institution. Besides, there are few corroborative studies about the rehabilitation of the reinstatement support. We applied a reinstatement support program for patients with depression in Hokkaido University Hospital and reviewed its efficacy. Subjects: In about 2 years, 25 patients (male:female=5:1) participated in a treatment program, and 22 cases accomplished it. Mean age of participants was 40.0±7.8 years old, and mean score of 17 items Hamilton depression scale was 5.2±3.2 at pretreatment. Method: The program consists of occupational therapy (OT) and group cognitive-behavioral therapy (CBGT) for improvement of the reinstatement readiness, the evaluation of the possibility to return to work and the prevention of recurrence. It is a program treated by multidisciplinary collaboration for 12 weeks. We performed various kinds of questionnaire and examination at pre and post treatment, and investigated the change of them and clinical outcome. Results: Among 22 people who finished our program, 16 people (73%) returned to work. One person of those recurred (mean duration of follow-up period: 10.3±6.9 months). It revealed significant improvement at post treatment in symptom of depression (BDI), dysfunctional cognitive thoughts (ATQ-R, JIBT-20) and psychosocial function (SF-36v2). Also, the abnormality of the neuropsychological cognitive function was found in many patients, but most of them were improved at post treatment. Improvement was obtained in particular from Wisconsin card sorting test and Auditory verbal learning test in domain such as working memory or executive function. Discussion: It was suggested that a reinstatement support program for depression was effective for not only improvement of social outcome but also prevention of recurrence of depression, or neurocognitive rehabilitation. As for measuring a cognitive function neuropsychologically, it may be useful as a clinical tool to know readiness of the reinstatement objectively. Further study about predictors of the reinstatement outcome or way of cooperation with the job side will be necessary in the future.
