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Articles   |    
Increase in Work Productivity of Depressed Individuals With Improvement in Depressive Symptom Severity
Madhukar H. Trivedi, M.D.; David W. Morris, Ph.D.; Stephen R. Wisniewski, Ph.D.; Ira Lesser, M.D.; Andrew A. Nierenberg, M.D.; Ella Daly, M.B., M.R.C.Psych.; Benji T. Kurian, M.D., M.P.H.; Bradley N. Gaynes, M.D.; G.K. Balasubramani, Ph.D.; A. John Rush, M.D.
Am J Psychiatry 2013;170:633-641. doi:10.1176/appi.ajp.2012.12020250
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Dr. Trivedi has received research support from or served as an adviser, consultant, or speaker for Abbott Laboratories, Abdi Ibrahim, Agency for Healthcare Research and Quality, Akzo (Organon Pharmaceuticals), Alkermes, AstraZeneca, Axon Advisors, Bristol-Myers Squibb, Cephalon, Corcept Therapeutics, Cyberonics, Eli Lilly, Evotec, Fabre Kramer Pharmaceuticals, Forest Pharmaceuticals, GlaxoSmithKline, Janssen Pharmaceutica Products, Johnson & Johnson PRD, Libby, Lundbeck, Mead Johnson, MedAvante, Medtronic, Merck, National Institute on Drug Abuse, NARSAD, Naurex, Neuronetics, NIMH, Novartis, Otsuka Pharmaceuticals, Pamlab, Parke-Davis Pharmaceuticals, Pfizer, PgxHealth, Pharmacia & Upjohn, Predix Pharmaceuticals (Epix), Rexahn Pharmaceuticals, Roche Products, Sepracor, Shire Development, Sierra, SK Life and Science, Solvay Pharmaceuticals, Takeda, Transcept, VantagePoint, and Wyeth-Ayerst Laboratories. Dr. Wisniewski has served as a consultant for Dey Pharmaceuticals and Venebio and has received grant support from Eli Lilly. Dr. Lesser has received grant support from NIMH. Dr. Nierenberg has received research support from or served as an adviser, consultant, or speaker for AstraZeneca, Basilea Pharmaceutica, Brain Cells, Bristol-Myers Squibb, Cederroth, Cyberonics, Dainippon Sumitomo, Eli Lilly, EpiQ, Forest Pharmaceuticals, Genaissance, GlaxoSmithKline, Janssen Pharmaceutica, Jazz Pharmaceuticals, Innapharma, Lichtwer Pharma, Eli Lilly, Merck, Neuronetics, Novartis, Organon, Pamlab, Pfizer, PGx Health, NIMH, NARSAD, Sepracor, Shire, Stanley Foundation, Targacept, Takeda, Wyeth-Ayerst Laboratories, and Massachusetts General Psychiatry Academy (MGHPA talks are supported through Independent Medical Education grants from AstraZeneca, Eli Lilly, and Janssen Pharmaceuticals); he has equity holdings (excluding mutual funds/blind trusts) in Appliance Computing. Dr. Daly is currently a full-time employee and stockholder of Johnson & Johnson PRD; at the time of this study, she was an assistant professor at the University of Texas Medical Center, Dallas, where she continues to hold a position as adjunct faculty. Dr. Kurian has received research grant support from Evotec, Forest Pharmaceuticals, Johnson & Johnson, Naurex, NIMH, Pfizer, Rexahn, and Targacept. Dr. Gaynes has received research support from or served as an adviser, consultant, or speaker for the Agency for Healthcare Research and Quality, Bristol-Myers Squibb, GlaxoSmithKline, M-3 Corporation, NIMH, Novartis, Ovation Pharmaceuticals, Pfizer, Robert Wood Johnson Foundation, Shire Pharmaceuticals, and Wyeth-Ayerst. Dr. Rush has received research support from Duke-National University of Singapore Graduate Medical School and NIMH; consulting fees from Brain Resource, Otsuka, and University of Michigan; speaking fees from Singapore College of Family Physicians; royalties from Guilford Publications and the University of Texas Southwestern Medical Center; and travel support from Collegium Internationale Neuro-Psychopharmacologicum. The other authors report no financial relationships with commercial interests.

Supported by NIMH contract N01MH90003 to University of Texas Southwestern Medical Center at Dallas (principal investigator, Dr. Rush). Medications for this trial were provided at no cost by Bristol-Myers Squibb, Forest Laboratories, GlaxoSmithKline, King Pharmaceuticals, Organon, Pfizer, and Wyeth.

Clinicaltrials.gov identifier: NCT00021528.

From the Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas; Epidemiology Data Center, Graduate School of Public Health, University of Pittsburgh, Pittsburgh; Department of Psychiatry, Geffen School of Medicine, University of California Los Angeles, Los Angeles; Clinical Psychopharmacology Unit, Massachusetts General Hospital, Boston; Department of Psychiatry, University of North Carolina, Chapel Hill; Duke-National University of Singapore Graduate Medical School, Singapore; and Johnson & Johnson Pharmaceutical Research and Development, Titusville, N.J.

Address correspondence to Dr. Trivedi (madhukar.trivedi@utsouthwestern.edu).

Copyright © 2013 by the American Psychiatric Association

Received February 21, 2012; Revised July 16, 2012; Revised December 07, 2012; Accepted December 17, 2012.

Abstract

Objective  The authors sought to identify baseline clinical and sociodemographic characteristics associated with work productivity in depressed outpatients and to assess the effect of treatment on work productivity.

Method  Employed depressed outpatients 18–75 years old who completed the Work Productivity and Activity Impairment scale (N=1,928) were treated with citalopram (20–40 mg/day) in the Sequenced Treatment Alternatives to Relieve Depression study. For patients who did not remit after an initial adequate antidepressant trial (level 1), either a switch to sertraline, sustained-release bupropion, or extended-release venlafaxine or an augmentation with sustained-release bupropion or buspirone was provided (level 2). Participants’ clinical and demographic characteristics and treatment outcomes were analyzed for associations with baseline work productivity and change in productivity over time.

Results  Education, baseline depression severity, and melancholic, atypical, and recurrent depression subtypes were all independently associated with lower benefit to work productivity domains. During level 1 treatment, work productivity in several domains improved with reductions in depressive symptom severity. However, these findings did not hold true for level 2 outcomes; there was no significant association between treatment response and reduction in work impairment. Results were largely confirmed when multiple imputations were employed to address missing data. During this additional analysis, an association was also observed between greater impairment in work productivity and higher levels of anxious depression.

Conclusions  Patients with clinically significant reductions in symptom severity during initial treatment were more likely than nonresponders to experience significant improvements in work productivity. In contrast, patients who achieved symptom remission in second-step treatment continued to have impairment at work. Patients who have demonstrated some degree of treatment resistance are more prone to persistent impairment in occupational productivity, implying a need for additional, possibly novel, treatments.

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FIGURE 1. Distribution of Hours Missed and Impaired Productivity Due to Health Problems at Baseline and Exit From Acute-Phase Treatment With Citaloprama

a The upper chart is based on item 2 of the Work Productivity and Activity Impairment scale; the lower chart is based on item 5, using a 0–10 scale in which 0 indicates no impairment.

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TABLE 1.Factors Independently Associated With Baseline Work Productivity Impairment in a Sample of Patients With Depression and Work Productivity Impairment, Stepwise Model (N=1,928)a
Table Footer Note

a Hours missed is based on item 2 of the Work Productivity and Activity Impairment Scale, and impaired productivity on item 5. The following factors were considered for entry into the model: race, ethnicity (Hispanic), gender, marital status, education, insurance status, age group, setting (primary care/specialty care), illness onset before age 18, family history of depression, history of attempted suicide, current major depressive episode ≥24 months in duration, recurrent depression, anxious depression, melancholic depression, atypical depression, number of psychiatric comorbidities, average monthly income, duration of current illness, and Cumulative Illness Rating Scale count. Regional center was forced into the model. QIDS-IVR=Quick Inventory of Depressive Symptomatology–Interactive Voice Response. QIDS-IVR parameter estimate is based on a 5-unit increase.

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TABLE 2.Factors Independently Associated With Work Productivity Impairment at Exit From Level 1 Treatment With Citalopram, Stepwise Model (N=1,100)a
Table Footer Note

a Hours missed is based on item 2 of the Work Productivity and Activity Impairment Scale, and impaired productivity on item 5. The following factors were considered for entry into the model: race, ethnicity (Hispanic), gender, marital status, education, insurance status, age group, setting (primary care/specialty care), illness onset before age 18, family history of depression, history of attempted suicide, current major depressive episode ≥24 months in duration, recurrent depression, anxious depression, melancholic depression, atypical depression, number of psychiatric comorbidities, average monthly income, duration of current illness, and Cumulative Illness Rating Scale count. Regional center was forced into the model. QIDS-IVR=Quick Inventory of Depressive Symptomatology–Interactive Voice Response. QIDS-IVR parameter estimate is based on a 5-unit increase.

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TABLE 3.Average Work Productivity Scores at Baseline and at Exit From Level 1 Treatment With Citalopram, by Depressive Symptom Status at Exita
Table Footer Note

a Hours missed is based on item 2 of the Work Productivity and Activity Impairment Scale; impairment score is based on item 5, using a 0–10 scale in which 0 indicates no impairment. Nonresponse is defined as an improvement <50% in score on the 16-item Quick Inventory of Depressive Symptomatology–Self-Report (QIDS-SR16) and a QIDS-SR16 score >5. Remission is defined as a QIDS-SR16 score ≤5.

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TABLE 4.Changes in Work Productivity Scores Associated With Level 2 Treatment Response (N=357)a
Table Footer Note

a Hours missed is based on item 2 of the Work Productivity and Activity Impairment Scale, and impairment on item 5; scores reflect changes in impairment from level 1 exit to level 2 exit. Participants included in this analysis were level 1 partial responders and nonresponders who reported work impairment at level 2 entrance and exit. Nonresponse is defined as an improvement <50% in score on the 16-item Quick Inventory of Depressive Symptomatology–Self-Report (QIDS-SR16) and a QIDS-SR16 score >5. Remission is defined as a QIDS-SR16 score ≤5.

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References

Murray  C;  Lopez  A:  Global Health Statistics: A Compendium of Incidence, Prevalence, and Mortality Estimates for Over 200 Conditions .  Cambridge,  Harvard School of Public Health, 1996
 
Murray  CJL;  Lopez  AD (eds):  The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability From Diseases, Injuries, and Risk Factors in 1990 and Projected to 2020, vol 1 .  Cambridge, Mass,  Harvard School of Public Health, on behalf of the World Health Organization and the World Bank, 1996
 
Stewart  WF;  Ricci  JA;  Chee  E;  Morganstein  D:  Lost productive work time costs from health conditions in the United States: results from the American Productivity Audit.  J Occup Environ Med 2003; 45:1234–1246
[CrossRef] | [PubMed]
 
Stewart  WF;  Ricci  JA;  Chee  E;  Hahn  SR;  Morganstein  D:  Cost of lost productive work time among US workers with depression.  JAMA 2003; 289:3135–3144
[CrossRef] | [PubMed]
 
Kessler  RC;  Akiskal  HS;  Ames  M;  Birnbaum  H;  Greenberg  P;  Hirschfeld  RMA;  Jin  R;  Merikangas  KR;  Simon  GE;  Wang  PS:  Prevalence and effects of mood disorders on work performance in a nationally representative sample of US workers.  Am J Psychiatry 2006; 163:1561–1568
[CrossRef] | [PubMed]
 
Adler  DA;  McLaughlin  TJ;  Rogers  WH;  Chang  H;  Lapitsky  L;  Lerner  D:  Job performance deficits due to depression.  Am J Psychiatry 2006; 163:1569–1576
[CrossRef] | [PubMed]
 
Druss  BG;  Schlesinger  M;  Allen  HM  Jr:  Depressive symptoms, satisfaction with health care, and 2-year work outcomes in an employed population.  Am J Psychiatry 2001; 158:731–734
[CrossRef] | [PubMed]
 
Veiel  HOF:  A preliminary profile of neuropsychological deficits associated with major depression.  J Clin Exp Neuropsychol 1997; 19:587–603
[CrossRef] | [PubMed]
 
Elliott  R:  Executive functions and their disorders.  Br Med Bull 2003; 65:49–59
[CrossRef] | [PubMed]
 
Silva  H;  Larach  V:  Treatment and recovery rate in depression: a critical analysis.  World J Biol Psychiatry 2000; 1:119–123
[CrossRef] | [PubMed]
 
Fava  M;  Rush  AJ;  Trivedi  MH;  Nierenberg  AA;  Thase  ME;  Sackeim  HA;  Quitkin  FM;  Wisniewski  S;  Lavori  PW;  Rosenbaum  JF;  Kupfer  DJ:  Background and rationale for the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study.  Psychiatr Clin North Am 2003; 26:457–494
[CrossRef] | [PubMed]
 
Rush  AJ;  Fava  M;  Wisniewski  SR;  Lavori  PW;  Trivedi  MH;  Sackeim  HA;  Thase  ME;  Nierenberg  AA;  Quitkin  FM;  Kashner  TM;  Kupfer  DJ;  Rosenbaum  JF;  Alpert  J;  Stewart  JW;  McGrath  PJ;  Biggs  MM;  Shores-Wilson  K;  Lebowitz  BD;  Ritz  L;  Niederehe  G; STAR*D Investigators Group:  Sequenced Treatment Alternatives to Relieve Depression (STAR*D): rationale and design.  Control Clin Trials 2004; 25:119–142
[CrossRef] | [PubMed]
 
Kobak  KA;  Taylor  LH;  Dottl  SL;  Greist  JH;  Jefferson  JW;  Burroughs  D;  Mantle  JM;  Katzelnick  DJ;  Norton  R;  Henk  HJ;  Serlin  RC:  A computer-administered telephone interview to identify mental disorders.  JAMA 1997; 278:905–910
[CrossRef] | [PubMed]
 
Hamilton  M:  A rating scale for depression.  J Neurol Neurosurg Psychiatry 1960; 23:56–62
[CrossRef] | [PubMed]
 
Hamilton  M:  Development of a rating scale for primary depressive illness.  Br J Soc Clin Psychol 1967; 6:278–296
[CrossRef] | [PubMed]
 
Rush  AJ;  Trivedi  MH;  Ibrahim  HM;  Carmody  TJ;  Arnow  B;  Klein  DN;  Markowitz  JC;  Ninan  PT;  Kornstein  S;  Manber  R;  Thase  ME;  Kocsis  JH;  Keller  MB:  The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), Clinician Rating (QIDS-C), and Self-Report (QIDS-SR): a psychometric evaluation in patients with chronic major depression.  Biol Psychiatry 2003; 54:573–583
[CrossRef] | [PubMed]
 
Trivedi  MH;  Rush  AJ;  Ibrahim  HM;  Carmody  TJ;  Biggs  MM;  Suppes  T;  Crismon  ML;  Shores-Wilson  K;  Toprac  MG;  Dennehy  EB;  Witte  B;  Kashner  TM:  The Inventory of Depressive Symptomatology, Clinician Rating (IDS-C) and Self-Report (IDS-SR), and the Quick Inventory of Depressive Symptomatology, Clinician Rating (QIDS-C) and Self-Report (QIDS-SR) in public sector patients with mood disorders: a psychometric evaluation.  Psychol Med 2004; 34:73–82
[CrossRef] | [PubMed]
 
Rush  AJ;  Bernstein  IH;  Trivedi  MH;  Carmody  TJ;  Wisniewski  S;  Mundt  JC;  Shores-Wilson  K;  Biggs  MM;  Woo  A;  Nierenberg  AA;  Fava  M:  An evaluation of the Quick Inventory of Depressive Symptomatology and the Hamilton Rating Scale for Depression: a Sequenced Treatment Alternatives to Relieve Depression trial report.  Biol Psychiatry 2006; 59:493–501
[CrossRef] | [PubMed]
 
Rush  AJ;  Gullion  CM;  Basco  MR;  Jarrett  RB;  Trivedi  MH:  The Inventory of Depressive Symptomatology (IDS): psychometric properties.  Psychol Med 1996; 26:477–486
[CrossRef] | [PubMed]
 
Linn  BS;  Linn  MW;  Gurel  L:  Cumulative Illness Rating Scale.  J Am Geriatr Soc 1968; 16:622–626
[PubMed]
 
Miller  MD;  Paradis  CF;  Houck  PR;  Mazumdar  S;  Stack  JA;  Rifai  AH;  Mulsant  B;  Reynolds  CF  3rd:  Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale.  Psychiatry Res 1992; 41:237–248
[CrossRef] | [PubMed]
 
Miller  M;  Tower  A:  A Manual of Guidelines for Scoring the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) .  Pittsburgh,  University of Pittsburgh, 1991
 
Zimmerman  M;  Mattia  JI:  A self-report scale to help make psychiatric diagnoses: the Psychiatric Diagnostic Screening Questionnaire.  Arch Gen Psychiatry 2001; 58:787–794
[CrossRef] | [PubMed]
 
Zimmerman  M;  Mattia  JI:  The Psychiatric Diagnostic Screening Questionnaire: development, reliability, and validity.  Compr Psychiatry 2001; 42:175–189
[CrossRef] | [PubMed]
 
Reilly  MC;  Zbrozek  AS;  Dukes  EM:  The validity and reproducibility of a work productivity and activity impairment instrument.  Pharmacoeconomics 1993; 4:353–365
[CrossRef] | [PubMed]
 
Ware  JE  Jr;  Sherbourne  CD:  The MOS 36-item short-form health survey (SF-36), I: conceptual framework and item selection.  Med Care 1992; 30:473–483
[CrossRef] | [PubMed]
 
Chirban  J;  Jacobs  R;  Warren  J;  Prakash  E;  Sodomsky  M;  Clarke  J:  The 36-item Short-Form Health Survey (SF-36) and the Work Productivity and Activity Impairment (WPAI) questionnaire in panic disorder.  Dis Manag Health Outcomes 1997; 1:154–164
[CrossRef]
 
Mundt  JC;  Marks  IM;  Shear  MK;  Greist  JH:  The Work and Social Adjustment Scale: a simple measure of impairment in functioning.  Br J Psychiatry 2002; 180:461–464
[CrossRef] | [PubMed]
 
Endicott  J;  Nee  J;  Harrison  W;  Blumenthal  R:  Quality of Life Enjoyment and Satisfaction Questionnaire: a new measure.  Psychopharmacol Bull 1993; 29:321–326
[PubMed]
 
Ware  JE  Jr;  Kosinski  M;  Keller  SD:  A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity.  Med Care 1996; 34:220–233
[CrossRef] | [PubMed]
 
Gandek  B;  Ware  JE;  Aaronson  NK;  Apolone  G;  Bjorner  JB;  Brazier  JE;  Bullinger  M;  Kaasa  S;  Leplege  A;  Prieto  L;  Sullivan  M:  Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project: International Quality of Life Assessment.  J Clin Epidemiol 1998; 51:1171–1178
[CrossRef] | [PubMed]
 
Mintz  J;  Mintz  LI;  Arruda  MJ;  Hwang  SS:  Treatments of depression and the functional capacity to work.  Arch Gen Psychiatry 1992; 49:761–768
[CrossRef] | [PubMed]
 
Simon  GE;  Chisholm  D;  Treglia  M;  Bushnell  D; LIDO Group:  Course of depression, health services costs, and work productivity in an international primary care study.  Gen Hosp Psychiatry 2002; 24:328–335
[CrossRef] | [PubMed]
 
Zhang  ML;  Rost  KM;  Fortney  JC:  Earnings changes for depressed individuals treated by mental health specialists.  Am J Psychiatry 1999; 156:108–114
[PubMed]
 
Berndt  ER;  Finkelstein  SN;  Greenberg  PE;  Howland  RH;  Keith  A;  Rush  AJ;  Russell  J;  Keller  MB:  Workplace performance effects from chronic depression and its treatment.  J Health Econ 1998; 17:511–535
[CrossRef] | [PubMed]
 
American Psychiatric Association (APA):  Diagnostic and Statistical Manual of Mental Disorders. DSM-IV-TR, Fourth Edition (Text Revision) .  Washington, DC,  American Psychiatric Association, 2000
 
Fava  GA;  Rafanelli  C;  Cazzaro  M;  Conti  S;  Grandi  S:  Well-being therapy: a novel psychotherapeutic approach for residual symptoms of affective disorders.  Psychol Med 1998; 28:475–480
[CrossRef] | [PubMed]
 
Trivedi  MH;  Rush  AJ;  Wisniewski  SR;  Nierenberg  AA;  Warden  D;  Ritz  L;  Norquist  G;  Howland  RH;  Lebowitz  B;  McGrath  PJ;  Shores-Wilson  K;  Biggs  MM;  Balasubramani  GK;  Fava  M; STAR*D Study Team:  Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice.  Am J Psychiatry 2006; 163:28–40
[CrossRef] | [PubMed]
 
Trivedi  MH;  Rush  AJ;  Gaynes  BN;  Stewart  JW;  Wisniewski  SR;  Warden  D;  Ritz  L;  Luther  JF;  Stegman  D;  Deveaugh-Geiss  J;  Howland  R:  Maximizing the adequacy of medication treatment in controlled trials and clinical practice: STAR*D measurement-based care.  Neuropsychopharmacology 2007; 32:2479–2489
[CrossRef] | [PubMed]
 
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