Gains in employment status following antidepressant medication or cognitive therapy for depression
Open accessAbstract
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 21 = 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 21 = 1.74, P = 0.19, OR = 1.77, 95% CI 0.75–4.17); however, we observed a site×treatment interaction (χ 21 = 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.
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Therapist experience, adherence, and ability to be responsive to individual patient differences are associated with better outcomes.
“Therapist experience, adherence, and ability to be responsive to individual patient differences are associated with better outcomes.54,55”
From Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder (2016) · cites this paper as [54]
The Methods (Acute Treatment; page unavailable) say therapist qualifications and adherence were characterized elsewhere, but do not link either to outcomes. The Discussion (page unavailable) raises differences in therapists’ techniques only as an untested explanation for site differences. Searches for therapist experience, adherence, and responsiveness to individual patients found no passage establishing the claimed association. (LLM, conf=0.77)
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References 36 · Cited by 36
Research works printed but not linked: 4
- [7]American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders Text Revision 4 American Psychiatric Press 2000
- [8]First M Spitzer R Gibbon M Williams J Structured Clinical Interview for DSM-IV-TR- Axis I Disorders, Research Version, Patient Edition With Psychotic Screen (SCID-I/P W/PSY SCREEN) Biometrics Research, New York State Psychiatric Institute 2001
- [11]Spitzer R Williams J Gibbon M First M Structured clinical interview for DSM-IIR personality disorders (SCID-II, Version 1.0) American Psychiatric Press 1990
- [31]Beck AT Rush AJ Shaw BF Emery G Cognitive Therapy of Depression The Guilford Press 1979
- Authors
- Fournier, J. C., DeRubeis, R. J., Amsterdam, J., Shelton, R. C., & Hollon, S. D.
- Affiliations
- University of Pittsburgh (US)
- Corresponding author
- Fournier, Jay C.
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2015-04
- Volume
- 206
- Issue
- 4
- Pages
- 332-338
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- PMC
- PMC4264990
- OpenAlex
- W1993520339
- Semantic Scholar
- 38656c421bc0537995f63cc7e806e2731b39a94f
- Cited by
- 36
- References
- 36
- Citations by year
- 2025: 1 · 2023: 2 · 2022: 4 · 2021: 5 · 2020: 1 · 2019: 3 · 2018: 4 · 2017: 2 · 2016: 10 · 2015: 2 · 2014: 2
- FWCI
- 3.89
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- GlaxoSmithKline
- National Institutes of Health
- National Institute of Mental Health (MH 060353, MH06099, MH 55875, MH-55877, K23MH097889, R01MH080097, R01MH060353, MH097889, MH077580, R34MH077580, R10MH055875, MH080097, R10MH055877)
- National Center for Complementary and Alternative Medicine (AT005074)
- National Center for Complementary and Integrative Health (AT005074, R01AT005074)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- depression, employment status, cognitive therapy, antidepressants, paroxetine, selective serotonin reuptake inhibitors, treatment response, long-term outcomes
- MeSH terms
- Antidepressive Agents, Depression, Depressive Disorder, Major, Major Depressive Disorder, Employment, Follow-Up Studies, Humans, Cognitive Behavioral Therapy, Odds Ratio, Treatment Outcome, Selective Serotonin Reuptake Inhibitors, Paroxetine
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