Initial depression severity and the trajectory of recovery following cognitive-behavioral intervention for work disability

J Occup Rehabil. 2006 Mar;16(1):63-74. doi: 10.1007/s10926-005-9013-0.


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%), chi(2)=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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cognitive Behavioral Therapy*
  • Depression / epidemiology
  • Depression / therapy*
  • Disability Evaluation
  • Employment
  • Fear / psychology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Musculoskeletal Diseases / psychology
  • Musculoskeletal Diseases / rehabilitation*
  • Occupational Diseases / psychology
  • Occupational Diseases / rehabilitation*
  • Pain / psychology
  • Pain / rehabilitation*
  • Pain Measurement
  • Severity of Illness Index
  • Workers' Compensation