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Return to Work After Depression-Related Absence by Employees With and Without Other Health Conditions: A Cohort Study

Ervasti, Jenni PhD; Vahtera, Jussi MD, PhD; Pentti, Jaana BSc; Oksanen, Tuula MD, PhD; Ahola, Kirsi PhD; Kivekäs, Teija MD, PhD; Kivimäki, Mika PhD; Virtanen, Marianna PhD

doi: 10.1097/PSY.0000000000000138

Objective Among employees with depression, diagnoses of other psychiatric and somatic conditions are common. However, few studies have examined whether the combined presence of depression and other psychiatric or somatic disorders adversely affects return to work after depression-related absence from work.

Methods We examined the association of present and recent psychiatric and somatic conditions and return to work after depression-related absence in a cohort of 9908 Finnish public sector employees with at least one such episode. The data included a total of 14,101 episodes during the period January 2005 to December 2011.

Results A total of 89% (n = 12,486) of depression-related absence episodes ended in return to work during the follow-up. For those episodes, the median length of absence was 34 days (interquartile range, 20–69 days). After adjustment for sex, age, socioeconomic status, and type of employment contract, present or recent psychiatric disorders other than depression (hazard ratio [HR] = 0.78, 95% confidence interval [CI] = 0.74–0.83), cancer (HR = 0.66, 95% CI = 0.47–0.92), diabetes (HR = 0.73, 95% CI = 0.62–0.86), cardiovascular disease (HR = 0.78, 95% CI = 0.62–0.99), hypertension (HR = 0.76, 95% CI = 0.67–0.85), musculoskeletal disorders (HR = 0.82, 95% CI = 0.77–0.87), and asthma (HR = 0.84, 95% CI = 0.75–0.94) were all associated with a lower likelihood of returning to work compared with depression episodes without other conditions.

Conclusions Among employees with depression-related absence, return to work is delayed in the presence of other psychiatric and somatic conditions. These findings suggest that other diseases should be taken into account when evaluating the outcome of depression-related absence. Randomized controlled trials are needed to examine whether integrated treatment of mental and physical disorders improves successful return to work after depression.

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From the Development of Work and Organizations (Ervasti, Vahtera, Pentti, Oksanen, Ahola, Kivekäs, Kivimäki, Virtanen). Finnish Institute of Occupational Health, Helsinki, Finland; Department of Public Health (Vahtera), University of Turku and Turku University Hospital, Turku, Finland; Department of Epidemiology and Public Health (Kivimäki), University College London, London, UK; and Department of Behavioral Sciences (Kivimäki), University of Helsinki, Helsinki, Finland.

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Address correspondence and reprint requests to Jenni Ervasti, PhD, Development of Work and Organizations, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, FI-00250 Helsinki, Finland. E-mail:

Received for publication April 2, 2014; revision received September 29, 2014.

Copyright © 2015 by American Psychosomatic Society
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