Introduction
Relationship between myocardial infarction, depression and work
Existing evidence for depression as a predictor of RTW after MI
Methods
Search Strategy
Concepts | Terms |
---|---|
Predictors | Determinants, factors, influences, risk, psychological, clinical, social, psycho social |
Work resumption | Return to work, loss of work, absenteeism |
Recovery | Cardiac rehabilitation, adjustment, lifestyle |
Employment | Work, full time, part time, workplace, vocation, job content, work limitations, productivity, work outcomes |
Quality of Life | Impairment, functionality, activity |
Demographic information | Age, gender, education, socio economic status, income |
Chronic disease | Myocardial Infarction, Acute Coronary Syndrome, Cardiovascular disease, Coronary Heart Disease, Coronary Artery Disease, depression, psychological distress, morbidity, co-morbidity |
Selection of studies
Results
Author | High 12 or more | Moderate 10-11 | Low 9 or less |
---|---|---|---|
Bhattacharyya (2007) [14] | ✓ | ||
Brink (2008) [30] | ✓ | ||
Fukuoka (2009) [28] | ✓ | ||
Engblom (1994) [27] | ✓ | ||
Ladwig (1994) [34] | ✓ | ||
Mayou (2000) [9] | ✓ | ||
McGee (2006) [35] | ✓ | ||
Mittag (2001) [33] | ✓ | ||
Soderman (2003) [5] | ✓ | ||
Soejima (1999) [31] | ✓ | ||
Sykes (2000) [32] | ✓ | ||
Samkange-Zeeb (2006) [29] | ✓ |
Population and design
Depression Measures
Definition of Work
Authors | Population | Assessment points | Depression measure | Definition of Return to Work (RTW) |
---|---|---|---|---|
Bhattacharyya (2007) [14] | N = 126 ACS patients | 7-10 days after admission, 12 months | BDI | Patients were asked when they had started work again and whether they were working full time or part time. |
Brink (2008) [30] | N = 88 MI patients | 4-6 months | HADS | Questionnaire about gainful employment, unemployment, early retirement, sick leave before and after MI |
Fukuoka (2009) [28] | N = 198 ACS patients | During hospitalisation, 2 and 6 months after hospital admission | BDI | Questionnaire about work status and the date participants returned to work. RTW was defined as starting back at work for more than 20 hours/week. |
Engblom (1994) [27] | N = 102 CABS male patients | Before CABG, 2 and 8 months after | BDI | Questionnaire, interview about work status (defined as paid employment, full or part time) and check of registry of Social Insurance Institution |
Ladwig (1994) [34] | N = 377 MI male patients | 17-21 days after event, 6 months | Validated 12-item version of depression composed of three subscales with rank-ordered ratings from 1 to 3 | Patients were asked to complete a questionnaire about vocational and social status at the time of participation. 'Have you returned to work?' |
Mayou (2000) [9] | N = 344 MI patients | 3 days after admission, 3 and 12 months | HADS | Insufficient |
McGee (2006) [35] | N = 363 ACS | In hospital, 12 months | BDI -FS, HADS-D | Questionnaire about RTW (full or part time employment) |
Mittag (2001) [33] | N = 119 males post MI or CABG patients | During hospitalisation, 12 months | CES-D/ADS Depression | Postal questionnaire, asking whether participants had resumed their occupations, if they were working in their former job or had changed to some other workplace, and if they were working full time or not. |
Soderman (2003) [5] | N = 198 CABG, PCTA patients | "Start of program," end of four week residential stay, 12 months | BDI | RTW was measured in two different ways, (a) RTW at full-time (100% of earlier working hours), and (b) RTW at reduced working hours |
Soejima (1999) [31] | N = 111 married males AMI patients | Average 24.8 days post admission (in hospital) Average 8 months | Cornell Medical Index, 6 item depression index | Three measures of RTW: whether participant had returned to work, interval in days between hospital discharge and resumption of work, and estimates of activity level at work compared with before MI |
Sykes (2000) [32] | N = 149 MI Patients | Baseline was pre discharge upon stabilising of condition and again at 12 months | Subscale of MMPI | Employment status was defined as returned to work or not, with information collected on patient occupation, Social Economic Status and work strain |
Samkange-Zeeb (2006) [29] | N = 620 CHD patients | Beginning of rehab, 6 and 12months post rehab | HADS (adjusted for Germany) | Current working situation and questionnaire on intention to RTW, disability and profession |
Impact of Depression on RTW
Author | Finding | Ratio | Depression severity | Estimate of relative risk | CI (95%) | P value | Variables included in multivariate analysis** (bold indicates significance) |
---|---|---|---|---|---|---|---|
DEPRESSION SIGNIFICANTLY PREDICTED RTW
| |||||||
6-8 MONTHS
| |||||||
Fukuoka (2009)[28] | As a time-dependent covariate, increases in depression score predicted slower RTW at 6 months | Adjusted Hazard ratio* | Moderate depression Severe depression | 0.47 0.37 | 0.31-0.72 0.21-0.66 | < 0.001 0.001 | Age, sex, nationality, education, income, marital status, smoking, hyperlipidemia, Duke activity index score (physical functioning), job strain,
job satisfaction, job security,
working hours
per week, shift work, social support (from supervisor, co-workers) |
Samkange-Zeeb (2006)[29] | Level of depression was significant predictor of RTW at 6 months | Adjusted Odds ratio | Borderline depression Clinical depression | 0.62 0.28 | 0.35-1.12 0.14-0.58 |
Age, sex, profession, anxiety, expectations
about work incapacity
and desire to RTW
| |
Soejima (1999)[31] | Depressed patients less likely to RTW at 8 months | Adjusted Odds ratio | 0.15 | 0.02-0.87 | < 0.031 |
Age, education, occupation, personality
type health locus of control | |
12-13 MONTHS
| |||||||
McGee (2006)[35] | Baseline depression significantly predicted RTW at 12 months | Adjusted Odds ratio | HADS depression | 0.2 | 0.06-0.6 | 0.007 | Prior ACS, age and sex |
Sykes (2000)[32] | Depression significant predictor of RTW at 12 months | Wald test | 7.335 (df = 1) | 0.0068 |
Decision latitude,
work social
interaction,
age, medical prognosis
(Coronary Prognostic Index)
| ||
Samkange-Zeeb (2006)[29] | Level of depression was significant predictor of RTW at 12 months | Adjusted Odds ratio | Borderline depression Clinical depression | 0.35 0.24 | 0.18-0.68 0.11-0.49 |
Age, sex,
profession, anxiety,
expectations about
work incapacity
and desire to RTW
| |
Soderman (2003) [5] | Clinical depression (BDI >16) predicted RTW at 12 months | Adjusted Odds ratio | Clinical depression Mild depression Clinical depression Mild depression | 9.43 (fulltime) 2.89 (fulltime) 5.44 (reduced hours) OR not shown | 3.15-28.21 1.08-7.70 1.60-18.53 | <0.001 0.0300 <0.0068 0.7848 | Gender, age,
education, exercise capacity |
Bhattacharyya (2007) [14] | Every increase in BDI index reduced likelihood of RTW at 12-13 months | Adjusted Odds ratio | 0.90 | 0.82-0.99 | 0.032 | Age, gender, risk of cardiac event, heart failure, antidepressant use,
Arrhythmia during
admission, recurrent
cardiac events
| |
DEPRESSION DID NOT SIGNIFICANTLY PREDICT RTW
| |||||||
6-12 MONTHS
|
Significant
predictors
| ||||||
Brink [30] | Somatic health better predictor of RTW than mental health at 6 months | Adjusted Odds ratio | Physical health component score Footsteps per day | 1.08 1.18 | 1.02-1.14 1.01-1.38 | 0.011 0.033 |
Physical health, age, footsteps
per day
|
Ladwig (1994) [34] | Depression as a significant predictor of RTW at 6 months (OR: 0.39, Cl 0.18-0.88), was lost after adjustment for age, social class, rehabilitation, recurrent infarction, cardiac events, helplessness (OR: 0.54 CI 0.22-1.31) | - | |||||
Mayou (2000) [9] | No significant differences in RTW between distressed and nondistressed at 12 months | - | |||||
Engblom [27] | At 12 months, patients' expectations of work, duration of absence from work before CABS and physical capacity of patients after surgery are important determinants of RTW after CABS | Adjusted Odds ratio | Self assessed work capacity at six months (Good vs Poor) Functional Class (Canadian CVD class I vs II-III) Patient expectation about work (RTW vs retire) Absence from work before the CABS (3 months or less) | 8.5 6.7 6.4 4.9 | 2.3-32.0 1.8-24.5 1.6-26.0 1.2-20.2 | 0.003 0.006 0.013 0.032 | Type of rehabilitation, previous MI, expectations
regarding work, physical strain of work,
duration of the
preoperative absence
from work, basic education, professional education, socioeconomic status, preoperative BDI score, final work load at exercise test, functional
class, patients' perception
of working capacity at
6 months after the CABS. |
Mittag [33] | Three variables predicted RTW at 12 months in 85% of all cases: (1) age, (2) patients' feelings about disability (3) physicians' views on the extent to which vocationally disabled | Adjusted Odds ratio | Age Self perceived disability Physician's view of disability | 1.22 3.02 1.61 | 1.10-1.34 2.48-3.57 1.16-2.07 | <0.01 <0.001 <0.05 | Results of exercise testing, optimistic coping style, family income, negative incentives for RTW, physicians' subjective prognosis as to re-employment, patients' wish to return to work, age,
self perceived vocational
disability, physician's
perception of patient disability. |