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Initial Depression Severity and the Trajectory of Recovery Following Cognitive-Behavioral Intervention for Work Disability

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Introduction: The present study examined the recovery trajectories of a group of mildly depressed and moderately-severely depressed injured workers enrolled in a 10-week community-based rehabilitation program. Methods: A sample of 168 individuals (75 women, 93 men) with a disabling musculoskeletal pain condition participated in the research. On the basis of BDI-II (1) scores at pre-treatment assessment, patients were classified as either mildly (BDI-II =9–16; N=68) or moderately-severely depressed (BDI-II >16; N: 100). Results: Both groups showed significant reductions in depression, but individuals in the (initially) moderately-severely depressed group were more likely to score in the depressed range of the BDI-II at post-treatment than individuals who were initially mildly depressed. For the mildly depressed group, early treatment reductions in pain catastrophizing, and perceived disability predicted improvement in depression scores. For the moderately-severely depressed group, none of the early treatment changes predicted improvement in depression; only late treatment reductions in pain catastrophizing and fear of movement/re-injury predicted improvement in depression. Chi-square analysis revealed that patients who were no longer depressed at post-treatment had the highest probability of returning to work (91%), followed by (post-treatment) mildly depressed patients (60%), and finally (post-treatment) moderately-severely depressed patients (26%), χ2=38.9, p < 0.001. Conclusion: In order to maximize return to work potential, the content, structure and duration of rehabilitation programs requires modification as a function of the injured workers level of the depression severity.

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ACKNOWLEDGMENT

The authors thank Ms. Wendy Waller for her assistance in data collection and data entry. The authors also thank the Workers’ Compensation Board of Nova Scotia for facilitating this program of research. This research was supported by grants from the Canadian Institutes of Health Research and the Social Sciences and Humanities Research Council of Canada. Portions of this research were presented at the Annual Meeting of the American Pain Society, Boston, MA, 2005

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Authors and Affiliations

  1. Department of Psychology, Université de Montréal, Montréal, Quebéc, Canada

    Michael J. L. Sullivan, Heather Adams & Pascal Thibault

  2. Institute of Health Promotion Research, University of British Columbia, Vancouver, British Columbia, Canada

    Marc Corbière

  3. Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada

    William D. Stanish

  4. Department of Psychology, Université de Montréal, C.P. 6128 Succ Centre Ville, Montréal, Quebéc, H3C 3J7, Canada

    Michael J. L. Sullivan

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  1. Michael J. L. Sullivan
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  2. Heather Adams
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Correspondence to Michael J. L. Sullivan.

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Sullivan, M.J.L., Adams, H., Thibault, P. et al. Initial Depression Severity and the Trajectory of Recovery Following Cognitive-Behavioral Intervention for Work Disability. J Occup Rehabil 16, 60–71 (2006). https://doi.org/10.1007/s10926-005-9013-0

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  • DOI: https://doi.org/10.1007/s10926-005-9013-0

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