A case management occupational health model to facilitate earlier return to work of NHS staff with common mental health disorders: a feasibility study

Background The NHS is the biggest employer in the UK. Depression and anxiety are common reasons for sickness absence among staff. Evidence suggests that an intervention based on a case management model using a biopsychosocial approach could be cost-effective and lead to earlier return to work for staff with common mental health disorders. Objective The objective was to assess the feasibility and acceptability of conducting a trial of the clinical effectiveness and cost-effectiveness of an early occupational health referral and case management intervention to facilitate the return to work of NHS staff on sick leave with any common mental health disorder (e.g. depression or anxiety). Design A multicentre mixed-methods feasibility study with embedded process evaluation and economic analyses. The study comprised an updated systematic review, survey of care as usual, and development of an intervention in consultation with key stakeholders. Although this was not a randomised controlled trial, the study design comprised two arms where participants received either the intervention or care as usual. Participants Participants were NHS staff on sick leave for 7 or more consecutive days but less than 90 consecutive days, with a common mental health disorder. Intervention The intervention involved early referral to occupational health combined with standardised work-focused case management. Control/comparator Participants in the control arm received care as usual. Primary outcome The primary outcome was the feasibility and acceptability of the intervention, study processes (including methods of recruiting participants) and data collection tools to measure return to work, episodes of sickness absence, workability (a worker’s functional ability to perform their job), occupational functioning, symptomatology and cost-effectiveness proposed for use in a main trial. Results Forty articles and two guidelines were included in an updated systematic review. A total of 49 of the 126 (39%) occupational health providers who were approached participated in a national survey of care as usual. Selected multidisciplinary stakeholders contributed to the development of the work-focused case management intervention (including a training workshop). Six NHS trusts (occupational health departments) agreed to take part in the study, although one trust withdrew prior to participant recruitment, citing staff shortages. At mixed intervention sites, participants were sequentially allocated to each arm, where possible. Approximately 1938 (3.9%) NHS staff from the participating sites were on sick leave with a common mental health disorder during the study period. Forty-two sick-listed NHS staff were screened for eligibility on receipt of occupational health management referrals. Twenty-four (57%) participants were consented: 11 (46%) received the case management intervention and 13 (54%) received care as usual. Follow-up data were collected from 11 out of 24 (46%) participants at 3 months and 10 out of 24 (42%) participants at 6 months. The case management intervention and case manager training were found to be acceptable and inexpensive to deliver. Possible contamination issues are likely in a future trial if participants are individually randomised at mixed intervention sites. Harms No adverse events were reported. Limitations The method of identification and recruitment of eligible sick-listed staff was ineffective in practice because uptake of referral to occupational health was low, but a new targeted method has been devised. Conclusion All study questions were addressed. Difficulties raising organisational awareness of the study coupled with a lack of change in occupational health referral practices by line managers affected the identification and recruitment of participants. Strategies to overcome these barriers in a main trial were identified. The case management intervention was fit for purpose and acceptable to deliver in the NHS. Trial registration Current Controlled Trials ISRCTN14621901. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 12. See the NIHR Journals Library website for further project information.

Immunoregulation and antidepressant effect of ketamine

Major depressive disorder (MDD) is a common mental health disorder that brings severe disease burden worldwide. Traditional antidepressants are mainly targeted at monoamine neurotransmitters, with low remission rates and high recurrence rates. Ketamine is a noncompetitive glutamate N-methyl-d-aspartate receptor (NMDAR) antagonist, and its rapid and powerful antidepressant effects have come to light. Its antidepressant mechanism is still unclarified. Research found that ketamine had not only antagonistic effect on NMDAR but also strong immunomodulatory effect, both of which were closely related to the pathophysiology of MDD. Although there are many related studies, they are relatively heterogeneous. Therefore, this review mainly describes the immune mechanisms involved in MDD and how ketamine plays an antidepressant role by regulating peripheral and central immune system, including peripheral inflammatory cytokines, central microglia, and astrocytes. This review summarizes the related research, finds out the deficiencies of current research, and provides ideas for future research and the development of novel antidepressants.

Eat to Beat Stress

There is a tendency to accept anxiety as an inevitable part of living in a stressful modern world. However, simple dietary changes can help attenuate the stress response. While there are several approaches to treating anxiety, research by Peter Roy-Byrne in 2015 has shown that only 50% to 60% of people respond to medication and psychotherapy, and only a quarter of patients have complete resolution of their symptoms. According to statistics from the National Institute of Mental health, prior to the COVID-19 pandemic, anxiety disorders were the most common mental health disorder in the United States, about 3 times more common than depression (18.1% vs 6.7%). A recent Express Scripts survey showed the percent increase in the number of new prescriptions for antianxiety medications by the middle March 2020 for antianxiety medications was 37.7%, underscoring the likely rise in anxiety associated with the pandemic. While traditional medications and therapies are well needed, to beat stress during times of a pandemic, it is important to think more broadly about how we can best affect our mental well-being. One of those ways is through our nutrition and dietary habits, and research by Opie et al in 2015 demonstrates that our dietary choices are more crucial than ever. This column reviews foods and substances that are important to consider in managing anxiety.

Democracy and Depression: A Cross-National Study of Depressive Symptoms and Nonparticipation

Depression is the most common mental health disorder. It has consequences not only on individuals but also on social and political levels. We argue that depressive symptoms impair political participation by reducing the motivation and physical energy of sufferers. We test our hypotheses by conducting regression analyses of four nationally representative cross-sectional and longitudinal surveys that collectively span many democracies. Our results are threefold. First, we find that the severest depressive symptoms lower the probability of voting by 0.05–0.25 points, an effect that is exceeded only by education and age. Second, we show that depressive symptoms negatively affect political interest and internal efficacy, thereby confirming that they diminish political motivation. Third, we find that depressive symptoms most strongly affect physically demanding acts, thereby confirming that they reduce the physical energy required for participation. We conclude by urging scholars to take depressive symptoms seriously in the study of political behavior.

A common mental health disorder. This topic choice ground of Pakistan and try clear the women and my country with others

Depression: is a mood disorder that causes a persistent feeling of sadness and loss of interest.Signs and symptoms of depression include:– depression and women: rates of depression in women are twice as high as they are in men;– depression in Pakistan: globally depression affects 20% of people while in Pakistan;– helping a depressed person: if you know someone who is depressed, it affects you too;– to help your friend or relative.Disclosure of interestThe author has not supplied his declaration of competing interest.