Jay C Fournier1, Robert J DeRubeis1, Jay Amsterdam1, Richard C Shelton1, Steven D Hollon1. 1. Jay C. Fournier, PhD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Robert J. DeRubeis, PhD, Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania; Jay Amsterdam, MD, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Richard C. Shelton, MD, Department of Psychiatry and Behavioral Neurobiology, The University of Alabama at Birmingham, Birmingham, Alabama; Steven D. Hollon, PhD, Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA.
Abstract
BACKGROUND: Depression can adversely affect employment status. AIMS: To examine whether there is a relative advantage of cognitive therapy or antidepressant medication in improving employment status following treatment, using data from a previously reported trial. METHOD: Random assignment to cognitive therapy (n = 48) or the selective serotonin reuptake inhibitor paroxetine (n = 93) for 4 months; treatment responders were followed for up to 24 months. Differential effects of treatment on employment status were examined. RESULTS: At the end of 28 months, cognitive therapy led to higher rates of full-time employment (88.9%) than did antidepressant medication among treatment responders (70.8%), χ(2) 1 = 5.78, P = 0.02, odds ratio (OR) = 5.66, 95% CI 1.16-27.69. In the shorter-term, the main effect of treatment on employment status was not significant following acute treatment (χ(2) 1 = 1.74, P = 0.19, OR = 1.77, 95% CI 0.75-4.17); however, we observed a site×treatment interaction (χ(2) 1 = 6.87, P = 0.009) whereby cognitive therapy led to a higher rate of full-time employment at one site but not at the other. CONCLUSIONS:Cognitive therapy may produce greater improvements in employment v. medication, particularly over the longer term. Royal College of Psychiatrists.
RCT Entities:
BACKGROUND:Depression can adversely affect employment status. AIMS: To examine whether there is a relative advantage of cognitive therapy or antidepressant medication in improving employment status following treatment, using data from a previously reported trial. METHOD: Random assignment to cognitive therapy (n = 48) or the selective serotonin reuptake inhibitor paroxetine (n = 93) for 4 months; treatment responders were followed for up to 24 months. Differential effects of treatment on employment status were examined. RESULTS: At the end of 28 months, cognitive therapy led to higher rates of full-time employment (88.9%) than did antidepressant medication among treatment responders (70.8%), χ(2) 1 = 5.78, P = 0.02, odds ratio (OR) = 5.66, 95% CI 1.16-27.69. In the shorter-term, the main effect of treatment on employment status was not significant following acute treatment (χ(2) 1 = 1.74, P = 0.19, OR = 1.77, 95% CI 0.75-4.17); however, we observed a site×treatment interaction (χ(2) 1 = 6.87, P = 0.009) whereby cognitive therapy led to a higher rate of full-time employment at one site but not at the other. CONCLUSIONS: Cognitive therapy may produce greater improvements in employment v. medication, particularly over the longer term. Royal College of Psychiatrists.
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