Getting down to business: an examination of occupational outcomes in cognitive behavioral therapy for depression

ABSTRACT

Depression is associated with unemployment and poor occupational functioning. Although cognitive behavioral therapy (CBT) has been shown to reduce depressive symptoms, the degree to which it improves occupational outcomes has received little attention. We investigated change in job status and presenteeism (i.e., the inability to focus on and accomplish work) over the course of CBT. We assessed employment status, presenteeism, depressive symptoms, cognitive style, and CBT skills at intake and posttreatment in a sample of 126 participants enrolled in a 16-week course of CBT for depression. Employment status significantly improved from pre to posttreatment, with 11 of the 27 patients (41%) seeking to improve their employment status achieving this goal. Among the 59 consistently employed patients, presenteeism decreased significantly over the course of treatment (d_z = 1.13). We also found, even after controlling for changes in symptoms, reductions in negative cognitive style (but not changes in CBT skills) were associated with reductions in presenteeism. Our findings suggest CBT patients experience positive changes in occupational outcomes, both in finding work and being more focused and productive at work. Changes in negative cognitive styles appeared to partly explain this latter change. We encourage future work examining CBT’s impact on occupational outcomes.

KEYWORDS:

• Cognitive behavioral therapy
• depression
• occupational outcomes
• cognitive style

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. Absenteeism is another important aspect of occupational functioning. Nonetheless, the economic costs of presenteeism have been estimated to be 14 times that of absenteeism in the U.S. (Evans-Lacko & Knapp, 2016). In addition, the number of days people with depression miss work related to absenteeism is relatively low over short periods (2.4 days per month; Lerner et al., 2004). We were concerned that we might not be able to reliably detect changes in absenteeism over the course of treatment and did not assess absenteeism in this study. We encourage researchers to consider its inclusion in future studies.

2. Nineteen patients were included in both subgroups, for a total of 67 patients from the full sample of 126 being included in this study. The remaining 59 patients were not included in this study. Patients who could not be included because of missing data included: those who dropped out of treatment (n = 21) and those who had incomplete data (n = 4). The remainder were not included because they were neither looking for work nor currently employed (e.g., patients who indicated they were retired or unemployed students not looking for work). Among those excluded were three patients who were employed at intake (and not seeking to improve their employment status) who reported no longer being employed at the end of treatment. Overall, those included versus not included in the study did not differ on intake depressive symptoms, sex, age, or median annual household income (all ps > .05).

3. Those who completed and dropped out of treatment did not differ on intake depression symptoms, sex, age, or median annual household income(all ps > .05).

4. The authors of this scale defined presenteeism as a positive attribute (i.e., the ability to concentrate and accomplish work despite an individual’s depressive symptoms). However, presenteeism is generally used to describe a negative outcome (i.e., an inability to concentrate and accomplish work despite an individual’s depressive symptoms). Like other investigators who have used this measure (e.g., Hutting et al., 2014; Neto et al., 2017), we reversed the scoring of this scale so higher scores reflected the more often used definition of presenteeism.