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Original Research

Predictors of Long-Term Return to Work and Symptom Remission in Sick-Listed Patients With Major Depression

Hiske L. Hees, MSc; Maarten W. J. Koeter, PhD; and Aart H. Schene, MD, PhD

Published: August 15, 2012

Article Abstract

Objective: Although major depressive disorder (MDD) has substantial negative effects on work outcomes, little is known regarding how to promote a return to work (RTW) after MDD-related sickness absence. The present study aimed to examine predictors across multiple domains for long-term RTW in patients who are sick-listed because of their MDD, and to compare these with predictors for long-term symptom remission.

Method: Participants (n = 117) were diagnosed with MDD according to DSM-IV criteria, absent from work for at least 25% of their contract hours, and referred by occupational physicians to outpatient treatment. Long-term full RTW (working the full number of contract hours for at least 4 weeks) and long-term symptom remission (Hamilton Depression Rating Scale score ≤ 7) were examined during the 18-month follow-up. Potential predictors (diagnostic, sociodemographic, personality, and work-related) were assessed at baseline. Data were collected from December 2007 to March 2011.

Results: Stepwise logistic regression analyses with backward elimination (P ≤ .05) resulted in a final prediction model including depression severity (odds ratio [OR] = 0.92; 95% CI, 0.87-0.97; P = .003), comorbid anxiety (OR = 0.21; 95% CI, 0.05-0.84; P = .028), work motivation (OR = 1.87; 95% CI, 1.18-2.96; P = .008), and conscientiousness (OR = 1.10; 95% CI, 1.02-1.18; P = .012) as predictors of long-term RTW. Long-term symptom remission was only predicted by depression severity (OR = 0.93; 95% CI, 0.89-0.98; P = .005).

Conclusions: Whereas long-term symptom remission is only predicted by diagnostic factors, long-term RTW is also predicted by personal and work-related factors. These findings provide suggestions for the development of new interventions to improve both symptom remission and long-term RTW in sick-listed patients with MDD.

Trial Registration: Dutch Trial Register identifier: NTR2057

J Clin Psychiatry 2012;73(8):e1048-e1055



Submitted: February 5, 2012; accepted March 28, 2012 (doi:10.4088/JCP.12m07699).


Corresponding author: Hiske Hees, MSc, Academic Medical Center, University of Amsterdam, Department of Psychiatry, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands (

Volume: 73

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