Effectiveness of short-term and long-term psychotherapy on work ability and functional capacity — A randomized clinical trial on depressive and anxiety disorders

Abstract

Background

Insufficient evidence exists about the effect of different therapies on work ability for patients with psychiatric disorders. The present study compares improvements in work ability in two short-term therapies and one long-term therapy.

Methods

In the Helsinki Psychotherapy Study, 326 outpatients with depressive or anxiety disorder were randomly assigned to long-term and short-term psychodynamic psychotherapy, and solution-focused therapy. The patients were followed for 3 years from the start of treatment. Primary outcome measures were the Work Ability Index (WAI), the Work-subscale (SAS-Work) of the Social Adjustment Scale (SAS-SR), Perceived Psychological Functioning Scale, the prevalence of patients employed or studying, and the number of sick-leave days.

Results

Work ability was statistically significantly improved according to WAI (15%), SAS-Work (17%), and Perceived Psychological Functioning Scale (21%) during the 3-year follow-up. No differences in the work ability scores were found between two short-term therapies. The short-term therapies showed 4–11% more improved work ability scores than long-term therapy at the 7 month follow-up point. During the second year of follow-up, no significant differences were found between therapies. After 3 years of follow-up, long-term therapy was more effective than the short-term therapies with 5–12% more improved scores. No differences in the prevalence of individuals employed or studying or in the number of sick-leave days were found between therapies during follow-up.

Conclusions

Short-term therapies give benefits more quickly than long-term therapy on work ability but in the long run long-term therapy is more effective than short-term therapies. More research is needed to confirm these findings.

Introduction

Psychiatric disorders are often accompanied by problems in work functioning (Murray and Lopez, 1997). The scope of work-related problems in depressive and anxiety disorders varies from temporary deficits due to loss of energy, decreased ability to concentrate and lowered work satisfaction to impairment of work performance due to more long-term cognitive, affective and interpersonal dysfunctioning, recurrent sick-leaves and occupational disability (Adler et al., 2006, Mintz et al., 1992). Problems in work ability are important reasons for patients to apply for psychotherapy and to receive insurance subsidization of treatments. Improvement in work ability is usually regarded as one central goal of the treatment (Kessler and Frank, 1997, Lazar et al., 2006).

Psychotherapy outcome studies have so far primarily focused on measuring changes in psychiatric symptoms. The efficacy of brief psychotherapies has been demonstrated in clinical trials with short or no follow-up (Anderson et al., 1995, Barber and Ellman, 1996, Barlow and Lehman, 1996, Clarkin et al., 1996, Knekt and Lindfors, 2004). A recent study on depressive and anxiety disorders showed that symptom reduction was stronger after long-term psychotherapy than after short-term therapies (Knekt et al., in press).

However, relatively little is known about the effects of different therapies on alleviating work impairment and functional disability as there are only a few studies on the subject. According to Mintz et al. (1992), improvements in symptoms of depression appeared to occur more rapidly than improvements in the area of work. A decrease in sick-leave days following long-term, mainly psychodynamic psychotherapies, has been reported in one cohort study (Lazar et al., 2006). Trials comparing short-term therapies with waiting-list or clinical management have indicated either some positive treatment effect (O'Hara et al., 2000, Telch et al., 1995) or no effect (Mintz et al., 1992, Piper et al., 1990, Scott et al., 2000) on perceived work ability. A combination of short-term psychodynamic psychotherapy with antidepressive medication has produced better work adjustment and fewer sick-leave days than medication alone (Burnand et al., 2002). In short-term trials work outcomes were better as the duration of treatment increased from very short (1 month) to a moderate length (10 months) (Mintz et al., 1992). As far as we know, however, there are no trials comparing the effectiveness of short-term and long-term psychotherapies on work ability and functional capacity.

In this randomized trial, we studied the improvement in work ability and functional capacity due to solution-focused therapy and short-term and long-term psychodynamic psychotherapy during a 3-year follow-up in patients suffering from depressive or anxiety disorder.