うつ病患者の復職支援の取り組みとその有効性(シンポジウム:職場のメンタルヘルス最前線,2008年,第49回日本心身医学会総会(札幌))  [in Japanese] Practice and Efficacy of Reinstatement Support Program for Patients with Depression(Symposium/The Latest Frontiers of Occupational Mental Health)  [in Japanese]

うつ病患者の社会復帰を円滑に進めることは臨床的・社会的に重要な課題であり,各方面から支援の取り組みが模索されているが,実証的検討は不足している.北海道大学病院精神科神経科において休職中の単極性うつ病の外来患者を対象に開始した復職支援プログラムの概要を紹介し,その効果と課題について検証した.集団認知行動療法と作業療法を組み合わせたプログラムを12週間施行し,その前後での各種検査値の変化および復職転帰を検討した.抑うつ症状,非機能的認知,心理社会機能において終了時に有意な改善がみられた.また,認知機能の異常が多くの患者で認められたが,終了時には一定の改善をみていた.プログラムを終了した22名のうち,すでに16名(73%)が復職していた.復職への基礎的準備性を改善する中間的ステップとしての有効性が確認されるとともに,復職可能性の客観的指標として認知機能検査の有用性が示唆された.今後の課題について考察を加えた.

Objectives: With the abrupt increase of depression patients, it is strongly requested to support them returning to work smoothly. Therefore various treatment programs have begun to be practiced in some institutions in our country. However, they are not unified, and it is made through trial and error in each institution. Besides, there are few corroborative studies about the rehabilitation of the reinstatement support. We applied a reinstatement support program for patients with depression in Hokkaido University Hospital and reviewed its efficacy. Subjects: In about 2 years, 25 patients (male:female=5:1) participated in a treatment program, and 22 cases accomplished it. Mean age of participants was 40.0±7.8 years old, and mean score of 17 items Hamilton depression scale was 5.2±3.2 at pretreatment. Method: The program consists of occupational therapy (OT) and group cognitive-behavioral therapy (CBGT) for improvement of the reinstatement readiness, the evaluation of the possibility to return to work and the prevention of recurrence. It is a program treated by multidisciplinary collaboration for 12 weeks. We performed various kinds of questionnaire and examination at pre and post treatment, and investigated the change of them and clinical outcome. Results: Among 22 people who finished our program, 16 people (73%) returned to work. One person of those recurred (mean duration of follow-up period: 10.3±6.9 months). It revealed significant improvement at post treatment in symptom of depression (BDI), dysfunctional cognitive thoughts (ATQ-R, JIBT-20) and psychosocial function (SF-36v2). Also, the abnormality of the neuropsychological cognitive function was found in many patients, but most of them were improved at post treatment. Improvement was obtained in particular from Wisconsin card sorting test and Auditory verbal learning test in domain such as working memory or executive function. Discussion: It was suggested that a reinstatement support program for depression was effective for not only improvement of social outcome but also prevention of recurrence of depression, or neurocognitive rehabilitation. As for measuring a cognitive function neuropsychologically, it may be useful as a clinical tool to know readiness of the reinstatement objectively. Further study about predictors of the reinstatement outcome or way of cooperation with the job side will be necessary in the future.