The effect of Remission Status on Work Functioning in Employed Patients Treated for Major Depressive Disorder

Background The ability to function at work is impaired in patients with major depressive disorder (MDD) but few clinical trials include occupational outcome assessments. This study examined whether symptom remission following treatment for MDD is associated with work functioning improvement. Methods We conducted a secondary analysis of a 12-week randomized clinical trial comparing escitalopram with or without telephone-administered cognitive therapy in employed patients with MDD (N = 86). Outcomes included the Montgomery-Åsberg Depression Rating Scale (MADRS) and validated, self-rated work functioning scales including the Lam Employment Absence and Productivity Scale (LEAPS), Work Performance Questionnaire (HPQ), and Sheehan Disability Scale (SDS). Remission was defined as MADRS score ≤10 at 12 weeks. Data were evaluated using analysis of covariance with baseline score as covariates. Results Remission status was associated with significant improvement in work performance as assessed by the LEAPS productivity subscale, HPQ overall performance, and the SDS work/school item; a trend ( P = .08) was observed with the HPQ productivity subscale. The effect sizes ( d = 0.23, 0.51, 0.36, and 0.43, respectively) indicate small to medium effects that are likely clinically significant. Conclusions The results of our study confirm that symptom remission following treatment is associated significantly with improvement in work performance and productivity, as measured by validated work functioning scales. Measurement-based care for MDD should include both symptom and functional outcome assessments.