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Research on Depression in the Workplace.

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Mental Health Matters Journal for Psychiatrists & GP's

MHM Volume 7 Issue1 small

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March 31, 2008 - Poststroke depression prevents almost as many stroke
survivors from returning to work as physical disability, new research

Investigators from the George Institute for International Health, in Sydney,
Australia, found that among stroke survivors who had paying jobs in the
month prior to their stroke, psychiatric morbidity 28 days poststroke was
associated with a significantly lower likelihood of returning to work,
second only to physical disability.

"Employment is a key determinant of one's role in society, and psychiatric
morbidity is a major cause for poor work performance and absence from the
workforce," the authors write.

Further, the study showed that only 30% of patients with poststroke
depression reported having any treatment for it at 6-month follow-up.

Led by Nick Glozier, MD, PhD, the study is published online March 27 in

Social Impact of Stroke Overlooked

According to the paper, despite the fact that up to 20% of strokes occur in
relatively young people of working age, few studies have looked at
determinants of returning to paid work following stroke.

"A striking number of people have strokes when they are of working age, and
returning to employment is vital to their well-being and to their role in
society. Since younger adults have responsibilities for generating an income
and supporting family members, returning to work is a key goal in recovery,"
Dr. Glozier said in a statement from the American Stroke Association.

To determine the frequency of returning to work and its predictors, the
investigators used data from the third Auckland Regional Community Stroke
(ARCOS) study, a prospective, population-based study that examined outcomes
of stroke survivors who were alive at least 6 months after a first stroke.

One week after their stroke, patients were assessed using the Barthel Index
(BI) to determine their ability to independently perform basic self-care and
activities of daily living.

At 28-day follow-up, patients' psychiatric status was assessed using the
28-item General Health Questionnaire (GHQ-28). Study subjects were followed
up again at 6 months.

Need for Greater Attention

Among 1423 patients registered with first-ever strokes, 279 (20%) had been
previously employed before their event. Of these, 55 died before 28 days, 24
were not cognitively competent at the 28-day interview, and 36 were either
unavailable or refused to participate, leaving 164 who had a GHQ-28
assessment at 1 month.

A total of 210 previously employed patients survived to 6 months and, of
these, 112 (53%) returned to work following acute stroke.

According to the study, the strongest predictor of not returning to work was
physical disability. Of those working at 6 months, 71% had been rated as
independent on the BI. In contrast, among those who did not return to work
only 32% been deemed physically independent.

Of those working 6 months after stroke, 33% had poststroke depression vs 45%
of those who were not working. According to the study, patients were more
likely to have poststroke depression if they were younger, had a more severe
stroke, or had previously been treated for depression.

According to the investigators, the study highlights the need for greater
attention to be paid to psychiatric morbidity in stroke patients.

"Specifically, there is a need for robust evaluations of interventions aimed
at the prevention, early detection, and effective management of psychiatric
morbidity, with this important patient-related outcome as a useful end
point. As well as improving quality of life, such strategies could assist in
the earlier return to work and economic productivity for younger patients
and families after stroke," they write.


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