Associations between antidepressant therapy, work ability, and sick leave for patients with common mental disorders within a two-year perspective – A longitudinal observational cohort study in Swedish primary care

Dominique Hange,Nashmil Ariai,Cecilia Björkelund,Irene Svenningsson,Shabnam Nejati,Eva-Lisa Petersson,Pia Augustsson,Ingmarie Skoglund

doi:10.1016/j.heliyon.2021.e07116

Abstract

BackgroundAn increasing number of patients are on sick leave because of common mental disorders (CMD), with or without antidepressant therapy. There is a lack of long-term follow-up studies in the primary care context, where most of the patients are treated. The importance of identifying potential factors associated with work ability for CMD patients is increasingly in focus. ObjectiveTo investigate the associations between using antidepressants, sick leave duration, reported work ability and psychological symptoms among patients with CMD during a two-year observation period in the primary care context. MethodsLongitudinal observational cohort study at 28 Primary Care Centers in Region Västra Götaland, Sweden, including 182 patients with an employment and on sick leave for CMD. The following outcomes were assessed: work ability measured with WAI, depressive symptoms with MADRS-S, anxiety symptoms with BAI, fatigue symptoms with KEDS, quality of life with EQ-5D, and days of sick leave. The data were compared between the groups that used and did not use antidepressants, during the 24-months observation period. ResultsWork ability and health-related quality of life increased over time in both groups. A steeper decrease of depressive symptoms, anxiety symptoms as well as an increased health-related quality of life at 3, 6 and 12 months was found in the group without antidepressants, although both groups levelled off at 24 months. In both groups, a higher work ability at baseline was associated with less two-year sick leave. ConclusionOur study indicates that a high work ability at baseline has a strong association with a lower total net and gross sick leave duration during the entire two-year follow-up period for patients with CMD in primary health care, irrespective of use of antidepressants. Using WAI in primary health care could therefore be helpful in predicting return to work. Use of antidepressants during the CMD episode could indicate initially a more pronounced overall symptom pattern, motivating introduction of antidepressants, rather than prolonging the sick leave period.

Highlights

With a growing number of patients on sick leave because of common mental disorders (CMD) in most Nordic and European countries, the importance of identifying potential factors associated with sick leave is increasingly in focus [1, 2]
In an earlier publication from the study group “Antidepressants in Depression, Anxiety Syndromes and Stress-related Mental Disorders” (ADAS), no significant differences in sick leave duration were observed between patients with CMD treated with antidepressants compared to those treated with other therapies during a 12-month follow-up period [5]
Montgomery Asberg Depression Rating Scale (MADRS)-S, EQ-5D, and Karolinska Exhaustion Disorder Scale (KEDS) levels were significantly associated to Work Ability (WAI) at baseline, but not at 24 months (Table 4). The aim of this longitudinal observational cohort study was to investigate whether use of antidepressants among patients on sick leave due to CMD was associated with their reported work ability during a twoyear period

Summary

Introduction

With a growing number of patients on sick leave because of common mental disorders (CMD) in most Nordic and European countries, the importance of identifying potential factors associated with sick leave is increasingly in focus [1, 2]. In an earlier publication from the study group “Antidepressants in Depression, Anxiety Syndromes and Stress-related Mental Disorders” (ADAS), no significant differences in sick leave duration were observed between patients with CMD treated with antidepressants compared to those treated with other therapies during a 12-month follow-up period [5]. A steeper decrease of depressive symptoms, anxiety symptoms as well as an increased health-related quality of life at 3, 6 and 12 months was found in the group without antidepressants, both groups levelled off at 24 months In both groups, a higher work ability at baseline was associated with less two-year sick leave. Conclusion: Our study indicates that a high work ability at baseline has a strong association with a lower total net and gross sick leave duration during the entire two-year follow-up period for patients with CMD in primary health care, irrespective of use of antidepressants. Use of antidepressants during the CMD episode could indicate initially a more pronounced overall symptom pattern, motivating introduction of antidepressants, rather than prolonging the sick leave period

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