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Parallel latent trajectories of mental health and personal earnings among 16- to 20 year-old US labor force participants: a 20-year longitudinal study. Soc Psychiatry Psychiatr Epidemiol 2022; 58:805-821. [PMID: 36566466 DOI: 10.1007/s00127-022-02398-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/12/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE Determine the number of latent parallel trajectories of mental health and employment earnings over two decades among American youth entering the workforce and estimate the association between baseline sociodemographic and health factors on latent trajectory class membership. METHODS This study used data of 8173 participants from the National Longitudinal Survey of Youth 1997 who were 13-17 years old in 1997. Surveys occurred annually until 2011 then biennially until 2017, when participants were 33-37 years old. The Mental Health Inventory-5 measured mental health at eight survey cycles between 2000 and 2017. Employment earnings were measured annually between 1998 and 2017. Latent parallel trajectories were estimated using latent growth modeling. Multinomial logistic regression explored the association between baseline factors and trajectory membership. RESULTS Four parallel latent classes were identified; all showed stable mental health and increasing earnings. Three percent of the sample showed a good mental health, steep increasing earnings trajectory (average 2017 earnings ~ $196,000); 23% followed a good mental health, medium increasing earnings trajectory (average 2017 earnings ~ $78,100); 50% followed a good mental health, low increasing earnings trajectory (average 2017 earnings ~ $39,500); and 24% followed a poor mental, lowest increasing earnings trajectory (average 2017 earnings ~ $32,000). Participants who were younger, women, Black or Hispanic, from lower socioeconomic households, and reported poorer health behaviors had higher odds of belonging to the poor mental health, low earnings class. CONCLUSION Findings highlight the parallel courses of mental health and labor market earnings, and the influence of gender, race/ethnicity, and adolescent circumstances on these processes.
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Dominiak M, Jażdżyk P, Antosik-Wójcińska AZ, Konopko M, Bieńkowski P, Świȩcicki Ł, Sienkiewicz-Jarosz H. The impact of bipolar spectrum disorders on professional functioning: A systematic review. Front Psychiatry 2022; 13:951008. [PMID: 36090375 PMCID: PMC9448890 DOI: 10.3389/fpsyt.2022.951008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/28/2022] [Indexed: 11/24/2022] Open
Abstract
AIMS The impact of bipolar spectrum (BS) disorders on professional functioning has not been systematically reviewed yet. Since even subsyndromal symptoms may disturb functioning, the determination of the prognostic value of the spectrum of bipolarity for employment seems extremely relevant. The aim of this study was to assess the impact of BS disorders on professional functioning. MATERIALS AND METHODS A systematic review of the literature (namely, cohort and cross-sectional studies) investigating a link between BS disorders and employment was performed in accordance with PRISMA guidelines. BS was defined based on the concept of two-dimensional BS by Angst. Occupational outcomes and factors affecting employment were evaluated as well. RESULTS Seventy-four studies were included. All disorders comprising BS had a negative impact on occupational status, work performance, work costs, and salary, with the greatest unfavorable effect reported by bipolar disorder (BD), followed by borderline personality disorder (BPD), major depressive disorder (MDD), and dysthymia. Employment rates ranged from 40 to 75% (BD), 33 to 67% (BPD), 61 to 88% (MDD), and 86% (dysthymia). The factors affecting employment most included: cognitive impairments, number/severity of symptoms, namely, subsyndromal symptoms (mainly depressive), older age, education, and comorbidity (substance abuse, personality disorders, anxiety, depression, ADHD, PTSD). CONCLUSION Bipolar spectrum symptoms exert a negative impact on professional functioning. Further evaluation of affecting factors is crucial for preventing occupational disability.
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Affiliation(s)
- Monika Dominiak
- Department of Pharmacology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Piotr Jażdżyk
- Department of Affective Disorders, Institute of Psychiatry and Neurology, Warsaw, Poland.,Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | | | - Magdalena Konopko
- First Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | - Łukasz Świȩcicki
- Department of Affective Disorders, Institute of Psychiatry and Neurology, Warsaw, Poland
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Sánchez J. Employment predictors and outcomes of U.S. state-federal vocational rehabilitation consumers with affective disorders: A CHAID analysis. J Affect Disord 2018; 239:48-57. [PMID: 29990662 DOI: 10.1016/j.jad.2018.06.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 05/19/2018] [Accepted: 06/15/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study examined the demographic and rehabilitation service variables affecting employment outcomes of people with affective disorders receiving services from U.S. state-federal vocational rehabilitation (VR) agencies. METHODS An ex post facto design, using data mining as a statistical analysis strategy, was used to analyze the Rehabilitation Services Administration Case Service Report (RSA-911) for the fiscal year 2011. The sample included 44,960 customers with affective disorders who were closed either as successfully employed (Status 26) or not employed (Status 28) by their VR agency. The dependent variable is employment outcome. The predictor variables include a set of personal characteristic variables and rehabilitation service variables. RESULTS The chi-squared automatic interaction detector (CHAID) data mining analysis results indicated that job placement services, on-the-job supports, and job search assistance services were significant predictors of successful employment outcomes for individuals with affective disorders. LIMITATIONS The study used data from the RSA-911 database. Causality cannot be inferred due to the use of archival data. CONCLUSIONS Employment should be viewed as a viable treatment outcome for individuals with affective disorders. Rehabilitation professionals should advocate for their clients to receive VR services, including job placement services, on-the-job supports, and job search assistance services in order to maximize their employment and mental health outcomes.
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Affiliation(s)
- Jennifer Sánchez
- Department of Rehabilitation and Counselor Education, The University of Iowa, N346 Lindquist Center, Iowa City, IA 52242, United States; Iowa Consortium for Substance Abuse Research and Evaluation, The University of Iowa, 2662 Crosspark Road, Coralville, IA 52241, United States; I-SERVE (Iowa-Support, Education, and Resources for Veterans and Enlisted), The University of Iowa, N122 Lindquist Center, Iowa City, IA 52242, United States.
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Kim EJ, Bahk YC, Oh H, Lee WH, Lee JS, Choi KH. Current Status of Cognitive Remediation for Psychiatric Disorders: A Review. Front Psychiatry 2018; 9:461. [PMID: 30337888 PMCID: PMC6178894 DOI: 10.3389/fpsyt.2018.00461] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/05/2018] [Indexed: 12/22/2022] Open
Abstract
Cognition is an important factor that affects daily functioning and quality of life. Impairment in cognitive function is a common symptom present in various psychological disorders, which hinders patients from functioning normally. Given that cognitive impairment has devastating effects, enhancing this in patients should lead to improvements in compromised quality of life and functioning, including vocational functioning. Over the past 50 years, several attempts have been made to improve impaired cognition, and empirical evidence for cognitive remediation (CR) has accumulated that supports its efficacy for treating schizophrenia. More recently, CR has been successfully applied in the treatment of depressive disorders, bipolar disorders, attention deficit/hyperactivity disorder, and anorexia nervosa. This study critically reviews recent CR studies and suggests their future direction. This study aimed to provide a modern definition of CR, and examine the current status of empirical evidence and representative CR programs that are widely used around the world.
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Affiliation(s)
- Eun Jin Kim
- Department of Psychology, Korea University, Seoul, South Korea
| | - Yong-Chun Bahk
- Department of Psychology, Korea University, Seoul, South Korea
| | - Hyeonju Oh
- Department of Psychology, Korea University, Seoul, South Korea
| | - Won-Hye Lee
- Department of Clinical Psychology, National Center for Mental Health, Seoul, South Korea
| | - Jong-Sun Lee
- Department of Psychology, Kangwon National University, Chuncheon, South Korea
| | - Kee-Hong Choi
- Department of Psychology, Korea University, Seoul, South Korea
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Kluwe-Schiavon B, Viola TW, Levandowski ML, Bortolotto VR, Souza LSAE, Tractenberg SG, Soares T. A systematic review of cognitive rehabilitation for bipolar disorder. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2015; 37:194-201. [DOI: 10.1590/2237-6089-2015-0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 05/19/2015] [Indexed: 11/21/2022]
Abstract
Introduction: It has been shown that bipolar disorder (BD) has a direct impact on neurocognitive functioning and behavior. This finding has prompted studies to investigate cognitive enhancement programs as potential treatments for BD, primarily focusing on cognitive reinforcement and daily functioning and not restricted to psychoeducation and coping strategies, unlike traditional psychosocial treatments. Objective: This study presents a systematic review of controlled trials of cognitive rehabilitation (CR) for BD. Our main objective is to describe the results of studies of rehabilitation programs for BD and related methodological issues. Method: Electronic database searches (MEDLINE, Web of Science, and Embase) were conducted to identify articles using terms related to BD and CR. The methodological quality of each article was measured using the 5-item Jadad scale. Results: A total of 239 articles were initially identified, but after application of exclusion criteria, only four were retained for this review. An average of 17 hours of intervention sessions were conducted, distributed as 0.95 hours per week and three of the four studies reported better executive function performance after CR interventions. Conclusions: We did not find robust evidence to support cognitive rehabilitation as an effective treatment for BD, because of: 1) the variety of intervention designs; 2) the methodological limitations of the studies; and 3) the lack of studies in the field.
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Arvilommi P, Suominen K, Mantere O, Valtonen H, Leppämäki S, Isometsä E. Predictors of long-term work disability among patients with type I and II bipolar disorder: a prospective 18-month follow-up study. Bipolar Disord 2015; 17:821-35. [PMID: 26621076 DOI: 10.1111/bdi.12349] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 10/12/2015] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Bipolar disorder (BD) is one of the leading causes of disability worldwide. However, vocational ability and predictors of long-term work disability have rarely been studied among patients with BD. We investigated clinical predictors of work disability among patients with BD in psychiatric care. METHODS The Jorvi Bipolar Study (JoBS) is a naturalistic prospective cohort study (N = 191) representing adult (18-59 years) psychiatric inpatients and outpatients with DSM-IV bipolar I disorder (BD-I) and bipolar II disorder (BD-II) in three Finnish cities. Within the JoBS, we investigated the prevalence of disability pensions at baseline, and predictors for being granted a disability pension during an 18-month follow-up of the 151 patients in the labor force at baseline. Cox models were used to determine predictors for onset of disability pension. RESULTS At baseline, 21% (40/191) of the patients already had a disability pension. During the follow-up, a further 38 patients (25% of the 151 followed) were granted a new disability pension. The predictors included older age, male gender, depressive index episode, higher number of psychiatric hospitalizations, generalized anxiety disorder, avoidant personality disorder, and depressive burden during follow-up. However, the predictors differed depending on bipolar subtype, age, and gender. CONCLUSIONS BD-I and BD-II are associated with a major risk of long-term work disability, the proportion of patients with a disability pension rising to 41% in the medium-term follow-up of the Finnish cohort investigated in the present study. Severe clinical course, depression, comorbidities, age, and gender are likely to be the main predictors but predictors may vary depending on the subgroup.
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Affiliation(s)
- Petri Arvilommi
- Unit of Mental Health, National Institute of Health and Welfare, Helsinki, Finland.,Psychiatric and Substance Abuse Services, Helsinki City Department of Social Services and Healthcare, Helsinki, Finland
| | - Kirsi Suominen
- Unit of Mental Health, National Institute of Health and Welfare, Helsinki, Finland.,Psychiatric and Substance Abuse Services, Helsinki City Department of Social Services and Healthcare, Helsinki, Finland
| | - Outi Mantere
- Unit of Mental Health, National Institute of Health and Welfare, Helsinki, Finland.,Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Valtonen
- Unit of Mental Health, National Institute of Health and Welfare, Helsinki, Finland.,Psychiatric and Substance Abuse Services, Helsinki City Department of Social Services and Healthcare, Helsinki, Finland
| | - Sami Leppämäki
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Finnish Institute of Occupational Health, Helsinki, Finland
| | - Erkki Isometsä
- Unit of Mental Health, National Institute of Health and Welfare, Helsinki, Finland.,Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Rizvi SJ, Cyriac A, Grima E, Tan M, Lin P, Gallaugher LA, McIntyre RS, Kennedy SH. Depression and employment status in primary and tertiary care settings. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:14-22. [PMID: 25886545 PMCID: PMC4314052 DOI: 10.1177/070674371506000105] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/01/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Major depressive disorder (MDD) is a leading cause of disability. Impairment in work function considerably adds to symptom burden and increases the economic impact of this disorder. Our study aimed to investigate the factors associated with work status in MDD within primary and tertiary care. METHOD We used data from 2 large databases for our analysis--Study 1: the InSight database, a chart review of MDD patients treated by primary care physicians across Canada (n=986); and Study 2: the International Mood Disorders Collaborative Project, a cross-sectional study of mood disorder patients (Canadian data only: n=274). RESULTS Both studies demonstrated high rates of unemployment and disability (30.3% to 42.1%). Quebec showed the highest rate of unemployment (21%) and British Columbia had the greatest percentage of patients on disability (15%). Employed and unemployed groups were similar based on clinical characteristics; however, unemployed people may have higher age, prevalence of medical comorbidity, and greater likelihood of receiving a benzodiazepine. Increased disability rates were associated with history of childhood abuse, duration of current major depressive episode, comorbidity, benzodiazepine use, as well as greater depression and anxiety severity. The unemployed-disability groups had greater somatic symptoms and anhedonia. In keeping with this, anhedonia was the strongest predictor of disability. Absenteeism was also high across both studies. CONCLUSIONS Unemployment and disability rates in MDD are high. The presence of anhedonia and medical comorbidity significantly influenced work status, emphasizing the need for treatment strategies to alleviate the additional symptom burden in this subpopulation.
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Affiliation(s)
- Sakina J Rizvi
- Scientific Associate, Department of Psychiatry, University Health Network, Toronto, Ontario; Clinical Research Coordinator, Department of Psychiatry, University Health Network, Toronto, Ontario
| | - Anna Cyriac
- Research Assistant, Department of Psychiatry, University Health Network, Toronto, Ontario
| | - Etienne Grima
- Chief Executive Officer, CardioComm Solutions, Canadian Heart Research Centre, Toronto, Ontario
| | - Mary Tan
- Statistician, Canadian Heart Research Centre, Toronto, Ontario
| | - Peter Lin
- Director, Canadian Heart Research Centre, Toronto, Ontario
| | | | - Roger S McIntyre
- Psychiatrist, Department of Psychiatry, University Health Network, Toronto, Ontario; Psychiatrist, Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, Ontario
| | - Sidney H Kennedy
- Psychiatrist, Department of Psychiatry, University Health Network, Toronto, Ontario; Professor, Department of Psychiatry and Institute of Medical Sciences, University of Toronto, Toronto, Ontario
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Katzman MA, Anand L, Furtado M, Chokka P. Food for thought: understanding the value, variety and usage of management algorithms for major depressive disorder. Psychiatry Res 2014; 220 Suppl 1:S3-14. [PMID: 25539872 DOI: 10.1016/s0165-1781(14)70002-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 10/11/2014] [Indexed: 12/28/2022]
Abstract
By 2020, depression is projected to be among the most important contributors to the global burden of disease. A plethora of data confirms that despite the availability of effective therapies, major depressive disorder continues to exact an enormous toll; this, in part, is due to difficulties reaching complete remission, as well as the specific associated costs of both the disorder's morbidity and mortality. The negative effects of depression include those on patients' occupational functioning, including absenteeism, presenteeism, and reduced opportunities for educational and work success. The use of management algorithms has been shown to improve treatment outcomes in major depressive disorder and may be less costly than "usual care" practices. Nevertheless, many patients with depression remain untreated. As well, even those who are treated often continue to experience suboptimal quality of life. As such, the treatment algorithms in this article may improve outcomes for patients suffering with depression. This paper introduces some of the principal reasons underlying these treatment gaps and examines measures or recommendations that might be changed or strengthened in future practice guidelines to bridge them.
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Affiliation(s)
- Martin A Katzman
- START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada; Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Department of Psychology, Lakehead University, Thunder Bay, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Adler Graduate Professional School, Toronto, ON, Canada.
| | - Leena Anand
- START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada
| | - Melissa Furtado
- START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada
| | - Pratap Chokka
- University of Alberta, Edmonton, AB, Canada; Chokka Center for Integrative Health, Edmonton, AB, Canada
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The effect of personality dimensions on functional outcomes in mood disorders. Adv Ther 2013; 30:671-83. [PMID: 23839119 DOI: 10.1007/s12325-013-0042-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Functional impairment associated with mood disorders may be related to a characteristic "profile" of normative personality dimensions. METHODS Individuals (age ≥ 18 years) with MDD (n = 400) or BD (n = 317), as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR), were enrolled in the IMDCP. Personality was evaluated with the Neuroticism-Extraversion-Openness Five-Factor Inventory (NEO-FFI), and functionality with the Sheehan Disability Scale and Endicott Work Productivity Scale. Path analysis using linear multiple regressions was performed to identify direct and indirect effects of personality on functional impairment. RESULTS Lower conscientiousness exerted a significant direct effect on global (p = 0.017) and family life dysfunction in individuals with MDD (p = 0.002), as well as lower work productivity in both MDD (p = 0.020) and BD (p = 0.018). Lower extraversion exerted a significant direct effect on social impairment in individuals with BD (p = 0.017). Higher neuroticism and agreeableness as well as lower extraversion exerted indirect effects on global and social dysfunction in individuals with MDD via their effects on depression severity. In BD, higher neuroticism and openness indirectly affected global dysfunction. Family dysfunction was indirectly affected by higher neuroticism and openness as well as lower extraversion in MDD and BD. CONCLUSION The results suggest that discrete personality dimensions may exert direct and indirect effects on functional outcomes in individuals with mood disorders. Personalizing disease management approaches in mood disorders with emphasis on vocational rehabilitation may benefit from measurement and intervention targeting personality.
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Symptomatic and functional improvement in employed depressed patients: a double-blind clinical trial of desvenlafaxine versus placebo. J Clin Psychopharmacol 2011; 31:569-76. [PMID: 21869698 DOI: 10.1097/jcp.0b013e31822c0a68] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE This is the first study to assess the efficacy of desvenlafaxine (administered as desvenlafaxine succinate) for improving depressive symptoms and functioning exclusively in employed patients with major depressive disorder (MDD). METHODS Gainfully employed (≥20 h/wk) male and female outpatients with MDD were randomly assigned (2:1 ratio) to 12 weeks of double-blind treatment with desvenlafaxine 50 mg/d or placebo. Analysis of covariance was used to compare differences in week 12 adjusted mean changes from baseline on the 17-item Hamilton Depression Rating Scale (HAM-D₁₇) (primary outcome) and Sheehan Disability Scale (SDS) (key secondary outcome) in the intent-to-treat (ITT) population. A predefined, modified ITT population (ie, those in the ITT population with baseline HAM-D₁₇ ≥20) was also analyzed. Tolerability was assessed by recording adverse events and change on the Arizona Sexual Experience Scale. RESULTS Baseline HAM-D₁₇ scores for desvenlafaxine (n = 285) and placebo (n = 142) were 22.0 and 21.8, whereas baseline SDS scores were 19.8 and 20.4. Adjusted mean differences between desvenlafaxine and placebo were 2.1 (95% confidence interval [CI], 0.78-3.46; P = 0.002) on the HAM-D₁₇ and 1.3 (95% CI, -0.09 to 2.76; P = 0.067) on the SDS. For the modified ITT sample, desvenlafaxine (n = 208) and placebo (n = 102), baseline HAM-D₁₇ scores were 23.8 and 23.9; the SDS baseline scores were 20.1 and 20.8. Mean differences were 2.6 (95% CI, 0.93-4.22; P = 0.002) on the HAM-D₁₇ and 2.1 (95% CI, 0.36-3.76; P = 0.017) on the SDS. Adverse events and Arizona Sexual Experience Scale scores were comparable between groups. CONCLUSIONS Desvenlafaxine 50 mg/d was efficacious for treating MDD in gainfully employed adults. Between-group differences on the SDS narrowly missed statistical significance in the ITT population alone, but the totality of data suggests functional improvements with active treatment.
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McIntyre RS, Liauw S, Taylor VH. Depression in the workforce: the intermediary effect of medical comorbidity. J Affect Disord 2011; 128 Suppl 1:S29-36. [PMID: 21220078 DOI: 10.1016/s0165-0327(11)70006-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND It is amply documented that mood disorders adversely affect job satisfaction, workforce productivity, and absenteeism/presenteeism. It is also well documented that mood disorders are an independent risk factor for several chronic medical disorders (e.g., obesity, diabetes mellitus, cardiovascular disease). Emerging evidence indicates that the workforce dysfunction associated with depression is partially mediated by medical comorbidity. METHODS We conducted a PubMed search of all English-language articles published between 2005 and July 2009 with the following search terms: major depressive disorder and depression, cross-referenced with work productivity, disability, economic cost, absenteeism, presenteeism, and medical comorbidity. Articles selected for review were based on adequacy of sample size, the use of standardized experimental procedures, validated assessment measures, and overall manuscript quality. RESULTS Mood disorders are the most impairing condition amongst working adults. It is estimated that approximately 35-50% of employees with depression will take short-term disability leave at some point during their job tenure. Moreover, 15-20% of the workforce will receive short-term disability benefits during any given year; the annual income of individuals affected by depression is reduced by approximately 10% when compared to unaffected employees. Chronic stress-sensitive conditions independently contribute to workforce maladjustment and associated disability. The mood disorder population is differentially affected by several stress-related medical conditions resulting in greater impairment in the workforce. CONCLUSION Disability modelling in the depressed employee has emphasized the complex interrelationship between depressive symptoms, workforce stress, and consequent disability. A more refined model must include the effects of chronic medical conditions as a powerful mediator and/or moderator of workforce impairment. Multidisciplinary interventions have been demonstrated to reduce, but not eliminate workforce disability related to depression, underscoring the need for elucidating other modifiable factors. Screening, treatment, and prevention initiatives need to target chronic medical conditions in depressed employees in order to reduce overall workforce disability.
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Piper ME, Loh WY, Smith SS, Japuntich SJ, Baker TB. Using decision tree analysis to identify risk factors for relapse to smoking. Subst Use Misuse 2010; 46:492-510. [PMID: 20397871 PMCID: PMC2908723 DOI: 10.3109/10826081003682222] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This research used classification tree analysis and logistic regression models to identify risk factors related to short- and long-term abstinence. Baseline and cessation outcome data from two smoking cessation trials, conducted from 2001 to 2002 in two Midwestern urban areas, were analyzed. There were 928 participants (53.1% women, 81.8% White) with complete data. Both analyses suggest that relapse risk is produced by interactions of risk factors and that early and late cessation outcomes reflect different vulnerability factors. The results illustrate the dynamic nature of relapse risk and suggest the importance of efficient modeling of interactions in relapse prediction.
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Affiliation(s)
- Megan E Piper
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin 53711, USA.
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