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PRISMA Study flow diagram of the study selection process.
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Figure 1

PRISMA Study flow diagram of the study selection process.

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Forest plot of comparison: 1 Work‐directed plus clinical versus clinical alone (medium term), outcome: 1.1 Days of sickness absence.
Figuras y tablas -
Figure 4

Forest plot of comparison: 1 Work‐directed plus clinical versus clinical alone (medium term), outcome: 1.1 Days of sickness absence.

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Forest plot of comparison: 5 Any antidepressant medication versus any other antidepressant medication, outcome: 5.1 Days of sickness absence.
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Figure 5

Forest plot of comparison: 5 Any antidepressant medication versus any other antidepressant medication, outcome: 5.1 Days of sickness absence.

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Forest plot of comparison: 9 Any psychological versus no intervention or care as usual, outcome: 9.1 Days of sickness absence.
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Figure 6

Forest plot of comparison: 9 Any psychological versus no intervention or care as usual, outcome: 9.1 Days of sickness absence.

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Comparison 1 Work‐directed plus clinical versus clinical alone (medium term), Outcome 1 Days of sickness absence.
Figuras y tablas -
Analysis 1.1

Comparison 1 Work‐directed plus clinical versus clinical alone (medium term), Outcome 1 Days of sickness absence.

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Comparison 1 Work‐directed plus clinical versus clinical alone (medium term), Outcome 2 Depressive symptoms.
Figuras y tablas -
Analysis 1.2

Comparison 1 Work‐directed plus clinical versus clinical alone (medium term), Outcome 2 Depressive symptoms.

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Comparison 1 Work‐directed plus clinical versus clinical alone (medium term), Outcome 3 Work functioning.
Figuras y tablas -
Analysis 1.3

Comparison 1 Work‐directed plus clinical versus clinical alone (medium term), Outcome 3 Work functioning.

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Comparison 2 Work‐directed plus clinical versus clinical alone (long term), Outcome 1 Days of sickness absence.
Figuras y tablas -
Analysis 2.1

Comparison 2 Work‐directed plus clinical versus clinical alone (long term), Outcome 1 Days of sickness absence.

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Comparison 2 Work‐directed plus clinical versus clinical alone (long term), Outcome 2 Depressive symptoms.
Figuras y tablas -
Analysis 2.2

Comparison 2 Work‐directed plus clinical versus clinical alone (long term), Outcome 2 Depressive symptoms.

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Comparison 2 Work‐directed plus clinical versus clinical alone (long term), Outcome 3 Work functioning.
Figuras y tablas -
Analysis 2.3

Comparison 2 Work‐directed plus clinical versus clinical alone (long term), Outcome 3 Work functioning.

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Comparison 3 Work‐directed plus clinical versus work‐directed (medium term), Outcome 1 Days of sickness absence.
Figuras y tablas -
Analysis 3.1

Comparison 3 Work‐directed plus clinical versus work‐directed (medium term), Outcome 1 Days of sickness absence.

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Comparison 3 Work‐directed plus clinical versus work‐directed (medium term), Outcome 2 Depressive symptoms.
Figuras y tablas -
Analysis 3.2

Comparison 3 Work‐directed plus clinical versus work‐directed (medium term), Outcome 2 Depressive symptoms.

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Comparison 4 Any work‐directed versus alternative work‐directed, Outcome 1 Days of sickness absence.
Figuras y tablas -
Analysis 4.1

Comparison 4 Any work‐directed versus alternative work‐directed, Outcome 1 Days of sickness absence.

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Comparison 4 Any work‐directed versus alternative work‐directed, Outcome 2 Depressive symptoms.
Figuras y tablas -
Analysis 4.2

Comparison 4 Any work‐directed versus alternative work‐directed, Outcome 2 Depressive symptoms.

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Comparison 5 Any antidepressant medication versus any other antidepressant medication, Outcome 1 Days of sickness absence.
Figuras y tablas -
Analysis 5.1

Comparison 5 Any antidepressant medication versus any other antidepressant medication, Outcome 1 Days of sickness absence.

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Comparison 5 Any antidepressant medication versus any other antidepressant medication, Outcome 2 Depressive symptoms.
Figuras y tablas -
Analysis 5.2

Comparison 5 Any antidepressant medication versus any other antidepressant medication, Outcome 2 Depressive symptoms.

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Comparison 5 Any antidepressant medication versus any other antidepressant medication, Outcome 3 Work functioning.
Figuras y tablas -
Analysis 5.3

Comparison 5 Any antidepressant medication versus any other antidepressant medication, Outcome 3 Work functioning.

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Comparison 6 Any antidepressant medication versus placebo, Outcome 1 Days of sickness absence.
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Analysis 6.1

Comparison 6 Any antidepressant medication versus placebo, Outcome 1 Days of sickness absence.

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Comparison 6 Any antidepressant medication versus placebo, Outcome 2 Work functioning.
Figuras y tablas -
Analysis 6.2

Comparison 6 Any antidepressant medication versus placebo, Outcome 2 Work functioning.

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Comparison 7 Any psychological versus other psychological (medium term), Outcome 1 Days of sickness absence.
Figuras y tablas -
Analysis 7.1

Comparison 7 Any psychological versus other psychological (medium term), Outcome 1 Days of sickness absence.

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Comparison 7 Any psychological versus other psychological (medium term), Outcome 2 Depressive symptoms.
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Analysis 7.2

Comparison 7 Any psychological versus other psychological (medium term), Outcome 2 Depressive symptoms.

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Comparison 7 Any psychological versus other psychological (medium term), Outcome 3 Work functioning.
Figuras y tablas -
Analysis 7.3

Comparison 7 Any psychological versus other psychological (medium term), Outcome 3 Work functioning.

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Comparison 8 Any psychological versus other psychological (long term), Outcome 1 Days of sickness absence.
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Analysis 8.1

Comparison 8 Any psychological versus other psychological (long term), Outcome 1 Days of sickness absence.

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Comparison 8 Any psychological versus other psychological (long term), Outcome 2 Depressive symptoms.
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Analysis 8.2

Comparison 8 Any psychological versus other psychological (long term), Outcome 2 Depressive symptoms.

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Comparison 8 Any psychological versus other psychological (long term), Outcome 3 Work functioning.
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Analysis 8.3

Comparison 8 Any psychological versus other psychological (long term), Outcome 3 Work functioning.

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Comparison 9 Any psychological versus no intervention or care as usual, Outcome 1 Days of sickness absence.
Figuras y tablas -
Analysis 9.1

Comparison 9 Any psychological versus no intervention or care as usual, Outcome 1 Days of sickness absence.

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Comparison 9 Any psychological versus no intervention or care as usual, Outcome 2 Depressive symptoms.
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Analysis 9.2

Comparison 9 Any psychological versus no intervention or care as usual, Outcome 2 Depressive symptoms.

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Comparison 10 Psychological combined with antidepressant medication versus antidepressant medication alone, Outcome 1 Days of sickness absence.
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Analysis 10.1

Comparison 10 Psychological combined with antidepressant medication versus antidepressant medication alone, Outcome 1 Days of sickness absence.

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Comparison 10 Psychological combined with antidepressant medication versus antidepressant medication alone, Outcome 2 Work functioning or productivity.
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Analysis 10.2

Comparison 10 Psychological combined with antidepressant medication versus antidepressant medication alone, Outcome 2 Work functioning or productivity.

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Comparison 10 Psychological combined with antidepressant medication versus antidepressant medication alone, Outcome 3 Depressive symptoms.
Figuras y tablas -
Analysis 10.3

Comparison 10 Psychological combined with antidepressant medication versus antidepressant medication alone, Outcome 3 Depressive symptoms.

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Comparison 11 Psychological combined with antidepressant medication versus no intervention or usual care (medium term), Outcome 1 Days of sickness absence.
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Analysis 11.1

Comparison 11 Psychological combined with antidepressant medication versus no intervention or usual care (medium term), Outcome 1 Days of sickness absence.

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Comparison 11 Psychological combined with antidepressant medication versus no intervention or usual care (medium term), Outcome 2 Employment status.
Figuras y tablas -
Analysis 11.2

Comparison 11 Psychological combined with antidepressant medication versus no intervention or usual care (medium term), Outcome 2 Employment status.

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Comparison 11 Psychological combined with antidepressant medication versus no intervention or usual care (medium term), Outcome 3 Depressive symptoms.
Figuras y tablas -
Analysis 11.3

Comparison 11 Psychological combined with antidepressant medication versus no intervention or usual care (medium term), Outcome 3 Depressive symptoms.

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Comparison 11 Psychological combined with antidepressant medication versus no intervention or usual care (medium term), Outcome 4 Depressed yes/no.
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Analysis 11.4

Comparison 11 Psychological combined with antidepressant medication versus no intervention or usual care (medium term), Outcome 4 Depressed yes/no.

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Comparison 11 Psychological combined with antidepressant medication versus no intervention or usual care (medium term), Outcome 5 Work functioning.
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Analysis 11.5

Comparison 11 Psychological combined with antidepressant medication versus no intervention or usual care (medium term), Outcome 5 Work functioning.

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Comparison 12 Exercise intervention versus no intervention or care as usual, Outcome 1 Days of sickness absence.
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Analysis 12.1

Comparison 12 Exercise intervention versus no intervention or care as usual, Outcome 1 Days of sickness absence.

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Comparison 12 Exercise intervention versus no intervention or care as usual, Outcome 2 Depressive symptoms.
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Analysis 12.2

Comparison 12 Exercise intervention versus no intervention or care as usual, Outcome 2 Depressive symptoms.

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Summary of findings for the main comparison. Work‐directed intervention plus clinical intervention compared to clinical intervention alone for depressive disorder

Work‐directed intervention plus clinical intervention compared to clinical intervention alone for depressive disorder

Patient or population: Persons with depressive disorder
Settings: Two studies were conducted in outpatient and one in a workplace or Employee Assistance Program
Intervention: Work‐directed intervention plus clinical intervention
Comparison: Clinical intervention alone

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Clinical intervention

Work‐directed intervention plus clinical intervention

Days of sickness absence
Follow up: 4 ‐ 12 months

The mean days of sickness absence in the intervention groups was
0.4 standard deviations lower
(0.66 to 0.14 lower)

SMD ‐0.4 (‐0.66 to ‐0.14)

251
(3 studies)

⊕⊕⊕⊝
moderate1

A standard deviation of 0.5 represents a moderate difference between groups

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; SMD: Standardised Mean Difference

Intervention description:

In two studies, an occupational therapy program focusing on work reintegration, combining modified work and supportive interventions was added to clinical care. In one study a regular Employee Assistance program was expanded and incorporated work coaching and modification.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Downgraded one level because N < 400

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Summary of findings for the main comparison. Work‐directed intervention plus clinical intervention compared to clinical intervention alone for depressive disorder
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Summary of findings 2. Any psychological intervention versus no intervention or care as usual for depressive disorder

Any psychological intervention versus no intervention or care as usual for depressive disorder

Patient or population: Persons with depressive disorder
Settings: One study was conducted in a workplace setting and two in primary care
Intervention: Any psychological intervention versus no intervention or care as usual (medium term)

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Care As Usual (CAU)

Any psychological intervention

Days of sickness absence
Follow up: 3 ‐ 8 months

The mean days of sickness absence in the intervention groups was
0.23 standard deviations lower
(0.45 to 0.01 lower)

SMD ‐0.23 (‐0.45 to ‐0.01)

326
(3 studies)

⊕⊕⊕⊝
moderate1

A standard deviation of 0.2 represents a small difference between groups

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CBT: Cognitive‐Behavioral Therapy; CAU: Care As Usual; CI: Confidence interval; SMD: Standardised Mean Difference

Intervention description

All three interventions were cognitive‐behavioral therapy, one by telephone and two online. Each of the interventions were interactive, with therapists or specialised nurses providing feedback.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Downgraded one level because N < 400

Figuras y tablas -
Summary of findings 2. Any psychological intervention versus no intervention or care as usual for depressive disorder
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Summary of findings 3. Psychological intervention combined with antidepressant medication versus no intervention or usual care for depressive disorder

Psychological intervention combined with antidepressant medication versus no intervention or usual care for depressive disorder

Patient or population: Persons with depressive disorders
Settings: Two studies were conducted in a primary care and one in a managed care setting
Intervention: Psychological intervention combined with antidepressant medication versus no intervention or usual care (medium term)

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Care As Usual (CAU)

Psychological intervention combined with antidepressant medication

Days of sickness absence ‐ Enhanced primary care versus CAU
Follow up: 7 ‐ 12 months

The mean days of sickness absence in the intervention groups was
0.02 standard deviations lower
(0.15 lower to 0.12 higher)

SMD ‐0.02 (‐0.15 to 0.12)

969
(2 studies)

⊕⊕⊝⊝
low1,2

A standard deviation of 0.2 represents a small difference between groups

Days of sickness absence ‐ Telephone outreach and care management program versus CAU
Follow up: mean 12 months

The mean days of sickness absence in the intervention groups was
0.21 standard deviations lower
(0.37 to 0.05 lower)

SMD ‐0.21 (‐0.37 to ‐0.05)

604
(1 study)

⊕⊕⊕⊕
high

A standard deviation of 0.2 represents a small difference between groups

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CAU: Care As Usual; CI: Confidence interval; SMD: Standardised Mean Difference

Intervention description

Enhanced primary care

General practitioners were enrolled in a quality improvement program and were expected to provide enhanced care including antidepressant medication and psychological interventions, according to primary care guidelines.

Telephone outreach and care management

This program systematically assessed needs for treatment, facilitated entry into in‐person treatment (both psychotherapy and antidepressant medication), monitored and supported treatment adherence, and (for those declining in‐person treatment) provided a structured psychotherapy intervention by telephone.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Downgraded with one level because all studies were of low quality
2 Downgraded with one level because in one study allocation concealment not adequate

Figuras y tablas -
Summary of findings 3. Psychological intervention combined with antidepressant medication versus no intervention or usual care for depressive disorder
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Table 1. Quality of the evidence (GRADE)

Comparison

Studies in comparison

Risk of Bias

Inconsistency

Indirectness

Imprecision

Publication bias

Quality of the

evidence

Work‐directed

Work‐directed + clinical intervention versus clinical (medium)

Hees 2013; Lerner 2012; Schene 2006

No: Majority low risk of bias

No: I² < 50%

No

Yes:

N < ‐400

Downgrade: ‐1

Undetected

Moderate

Work‐directed + clinical intervention versus clinical (long)

Hees 2013; Schene 2006

No: Majority low risk of bias

No: I² < 50%

No

Yes:

N < ‐400

Downgrade: ‐1

Undetected

Moderate

Work‐directed + clinical versus work‐directed

Vlasveld 2013

No: study with low risk of bias

N.a.

No

Yes:

Single study

Downgrade:

‐1

Undetected

Moderate

Work‐directed versus work‐directed

Noordik 2013

Yes: very serious

Downgrade

‐2

N.a.

No

Yes: wide CI

Downgrade:

‐1

Undetected

Very low

Clinical, medication

Medication:

SSRI versus SNRI

Fernandez 2005; Romeo 2004; Wade 2008

Fernandez: low

Romeo: high

Wade: high

Yes: 83%, pooling not feasible

No

Yes:

Single studies

Downgrade:

‐1

Undetected

Fernandez: moderate

Romeo: Low

Wade: Low

SSRI versus TCA

Miller 1998

Yes: very serious

Downgrade ‐2

N.a.

No

No

Undetected

Low

SSRI versus SSRI

Fantino 2007

No: study with low risk of bias

N.a.

No

Yes:

N< ‐400

Downgrade: ‐1

Undetected

Moderate

TCA or MAO versus placebo

Agosti 1991

Yes: very serious

Downgrade ‐2

N.a.

No

Yes:

N < ‐400

Downgrade: ‐1

Undetected

Very low

Clinical, psychological

Any psych versus other psych (medium)

Knekt 2013 (three arms)

Yes: serious Downgrade ‐1

Yes: 99% pooling not feasible

No

Yes: single study arms

Downgrade ‐1

Undetected

Knekt I: Low

Knekt II: Low

Any psych versus other psych (medium)

Knekt 2013 (three arms)

Yes: serious Downgrade ‐1

Yes: 99% pooling not feasible

No

Yes: single study arms

Downgrade ‐1

Undetected

Knekt I: Low

Knekt II: Low

Any psych versus CAU

Bee 2010; Hollinghurst 2010; McCrone 2004

No: Majority low risk of bias

No: I² < 50%

No

Yes:

N < ‐400

Downgrade: ‐1

Undetected

Moderate

CMHN versus CAU

Kendrick 2005 (three arms)

Yes: serious Downgrade ‐1

No: I² < 50%

No

Yes: wide CI

Downgrade:

‐1

Undetected

Low

Clinical, psychological and medication

Psych + med versus medicine

Burnand 2002

Yes: very serious

Downgrade

‐2

N.a.

No

Yes:

N < ‐400

Downgrade: ‐1

Undetected

Very low

Enhanced primary care versus CAU

Rost 2004; Schoenbaum 2001; Simon 1998

Yes: very serious

Downgrade

‐2

No: I² < 50%

No

No

Undetected

Low

Telephone outreach versus CAU

Wang 2007

No: study with low risk of bias

N.a.

No

No (n > 400 * CI not wide)

Undetected

High

Clinical, exercise

Strength versus relax

Krogh 2009

Yes: serious Downgrade ‐1

N.a.

No

Yes:

N < ‐400

Downgrade: ‐1

Undetected

Low

Aerobic versus relax or stretching

Krogh 2009; Krogh 2012

No: Majority low risk of bias

No: I² < 50%

No

Yes:

N < ‐400

Downgrade: ‐1

Undetected

Moderate
Figuras y tablas -
Table 1. Quality of the evidence (GRADE)
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Comparison 1. Work‐directed plus clinical versus clinical alone (medium term)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Days of sickness absence Show forest plot

3

251

Std. Mean Difference (IV, Random, 95% CI)

‐0.40 [‐0.66, ‐0.14]

1.1 Occupational therapy plus CAU vs. CAU

2

179

Std. Mean Difference (IV, Random, 95% CI)

‐0.30 [‐0.61, 0.01]

1.2 Multi‐component work‐focused program vs. CAU

1

72

Std. Mean Difference (IV, Random, 95% CI)

‐0.66 [‐1.15, ‐0.16]

2 Depressive symptoms Show forest plot

3

251

Std. Mean Difference (IV, Random, 95% CI)

‐0.32 [‐0.88, 0.25]

2.1 Occupational therapy plus CAU vs. CAU

2

179

Std. Mean Difference (IV, Random, 95% CI)

‐0.08 [‐0.66, 0.50]

2.2 Multi‐component work‐focused program vs. CAU

1

72

Std. Mean Difference (IV, Random, 95% CI)

‐0.84 [‐1.34, ‐0.33]

3 Work functioning Show forest plot

2

189

Std. Mean Difference (IV, Random, 95% CI)

‐0.31 [‐0.79, 0.16]

3.1 Occupational therapy plus CAU vs. CAU

1

117

Std. Mean Difference (IV, Random, 95% CI)

‐0.09 [‐0.48, 0.29]

3.2 Multi‐component work‐focused program vs. CAU

1

72

Std. Mean Difference (IV, Random, 95% CI)

‐0.58 [‐1.08, ‐0.09]
Figuras y tablas -
Comparison 1. Work‐directed plus clinical versus clinical alone (medium term)
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Comparison 2. Work‐directed plus clinical versus clinical alone (long term)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Days of sickness absence Show forest plot

2

179

Std. Mean Difference (IV, Random, 95% CI)

‐0.19 [‐0.49, 0.12]

1.1 Occupational therapy plus CAU vs. CAU

2

179

Std. Mean Difference (IV, Random, 95% CI)

‐0.19 [‐0.49, 0.12]

2 Depressive symptoms Show forest plot

1

117

Std. Mean Difference (IV, Random, 95% CI)

‐0.63 [‐1.02, ‐0.24]

2.1 Occupational therapy plus CAU vs. CAU

1

117

Std. Mean Difference (IV, Random, 95% CI)

‐0.63 [‐1.02, ‐0.24]

3 Work functioning Show forest plot

1

117

Std. Mean Difference (IV, Random, 95% CI)

‐0.25 [‐0.63, 0.14]

3.1 Occupational therapy plus CAU vs. CAU

1

117

Std. Mean Difference (IV, Random, 95% CI)

‐0.25 [‐0.63, 0.14]
Figuras y tablas -
Comparison 2. Work‐directed plus clinical versus clinical alone (long term)
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Comparison 3. Work‐directed plus clinical versus work‐directed (medium term)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Days of sickness absence Show forest plot

1

126

Std. Mean Difference (IV, Random, 95% CI)

‐0.14 [‐0.49, 0.21]

1.1 Collaborative care vs. CAU

1

126

Std. Mean Difference (IV, Random, 95% CI)

‐0.14 [‐0.49, 0.21]

2 Depressive symptoms Show forest plot

1

74

Std. Mean Difference (IV, Random, 95% CI)

0.26 [‐0.20, 0.72]

2.1 Collaborative care vs. CAU

1

74

Std. Mean Difference (IV, Random, 95% CI)

0.26 [‐0.20, 0.72]
Figuras y tablas -
Comparison 3. Work‐directed plus clinical versus work‐directed (medium term)
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Comparison 4. Any work‐directed versus alternative work‐directed

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Days of sickness absence Show forest plot

1

75

Std. Mean Difference (IV, Random, 95% CI)

0.45 [‐0.00, 0.91]

1.1 RTW‐E vs. CAU

1

75

Std. Mean Difference (IV, Random, 95% CI)

0.45 [‐0.00, 0.91]

2 Depressive symptoms Show forest plot

1

40

Std. Mean Difference (IV, Random, 95% CI)

‐0.18 [‐0.84, 0.49]

2.1 RTW‐E vs. CAU

1

40

Std. Mean Difference (IV, Random, 95% CI)

‐0.18 [‐0.84, 0.49]
Figuras y tablas -
Comparison 4. Any work‐directed versus alternative work‐directed
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Comparison 5. Any antidepressant medication versus any other antidepressant medication

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Days of sickness absence Show forest plot

5

Std. Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1 SSRI vs. SNRI

3

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 SSRI vs. TCA

1

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 SSRI vs. SSRI

1

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Depressive symptoms Show forest plot

5

1514

Std. Mean Difference (IV, Random, 95% CI)

0.07 [‐0.34, 0.48]

2.1 SSRI vs. SNRI

3

599

Std. Mean Difference (IV, Random, 95% CI)

0.18 [‐0.37, 0.73]

2.2 SSRI vs. TCA

1

635

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2.3 SSRI vs. SSRI

1

280

Std. Mean Difference (IV, Random, 95% CI)

‐0.23 [‐0.47, 0.00]

3 Work functioning Show forest plot

1

635

Mean Difference (IV, Random, 95% CI)

‐0.05 [‐0.16, 0.06]

3.1 SSRI vs. TCA

1

635

Mean Difference (IV, Random, 95% CI)

‐0.05 [‐0.16, 0.06]
Figuras y tablas -
Comparison 5. Any antidepressant medication versus any other antidepressant medication
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Comparison 6. Any antidepressant medication versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Days of sickness absence Show forest plot

1

61

Std. Mean Difference (IV, Random, 95% CI)

0.48 [‐0.05, 1.00]

1.1 TCA or MAO vs. placebo

1

61

Std. Mean Difference (IV, Random, 95% CI)

0.48 [‐0.05, 1.00]

2 Work functioning Show forest plot

1

61

Std. Mean Difference (IV, Random, 95% CI)

‐0.58 [‐1.11, ‐0.05]

2.1 TCA or MAO vs. placebo

1

61

Std. Mean Difference (IV, Random, 95% CI)

‐0.58 [‐1.11, ‐0.05]
Figuras y tablas -
Comparison 6. Any antidepressant medication versus placebo
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Comparison 7. Any psychological versus other psychological (medium term)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Days of sickness absence Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

1.1 Short‐term psychodynamic therapy vs. solution‐focused therapy

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

1.2 Long‐term psychodynamic therapy vs. solution‐focused therapy

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2 Depressive symptoms Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

2.1 Short‐term psychodynamic therapy vs. solution‐focused therapy

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 Long‐term psychodynamic therapy vs. solution‐focused therapy

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3 Work functioning Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

3.1 Short‐term psychodynamic therapy vs solution‐focused therapy

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Long‐term psychodynamic therapy vs solution‐focused therapy

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]
Figuras y tablas -
Comparison 7. Any psychological versus other psychological (medium term)
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Comparison 8. Any psychological versus other psychological (long term)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Days of sickness absence Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 Short‐term psychodynamic therapy vs. solution‐focused therapy

1

36

Std. Mean Difference (IV, Random, 95% CI)

‐0.91 [‐1.62, ‐0.19]

1.2 Long‐term psychodynamic therapy vs. solution‐focused therapy

1

42

Std. Mean Difference (IV, Random, 95% CI)

‐4.61 [‐5.84, ‐3.39]

2 Depressive symptoms Show forest plot

1

263

Std. Mean Difference (IV, Random, 95% CI)

‐1.85 [‐2.99, ‐0.72]

2.1 Short‐term psychodynamic therapy vs. solution‐focused therapy

1

118

Std. Mean Difference (IV, Random, 95% CI)

‐1.28 [‐1.69, ‐0.86]

2.2 Long‐term psychodynamic therapy vs. solution‐focused therapy

1

145

Std. Mean Difference (IV, Random, 95% CI)

‐2.44 [‐2.90, ‐1.97]

3 Work functioning Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

3.1 Short‐term psychodynamic therapy vs. solution‐focused therapy

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Long‐term psychodynamic therapy vs. solution‐focused therapy

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]
Figuras y tablas -
Comparison 8. Any psychological versus other psychological (long term)
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Comparison 9. Any psychological versus no intervention or care as usual

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Days of sickness absence Show forest plot

4

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 Online/telephone CBT vs. CAU

3

326

Std. Mean Difference (IV, Random, 95% CI)

‐0.23 [‐0.45, ‐0.01]

1.2 CMHN vs. usual GP care

1

59

Std. Mean Difference (IV, Random, 95% CI)

0.22 [‐0.36, 0.79]

2 Depressive symptoms Show forest plot

4

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 Online/telephone CBT vs. CAU

3

408

Std. Mean Difference (IV, Random, 95% CI)

‐0.56 [‐0.76, ‐0.36]

2.2 CMHN vs. usual GP care

1

78

Std. Mean Difference (IV, Random, 95% CI)

0.22 [‐0.31, 0.75]
Figuras y tablas -
Comparison 9. Any psychological versus no intervention or care as usual
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Comparison 10. Psychological combined with antidepressant medication versus antidepressant medication alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Days of sickness absence Show forest plot

1

57

Std. Mean Difference (IV, Random, 95% CI)

‐0.71 [‐1.25, ‐0.17]

1.1 Psychodynamic therapy plus TCA vs. TCA

1

57

Std. Mean Difference (IV, Random, 95% CI)

‐0.71 [‐1.25, ‐0.17]

2 Work functioning or productivity Show forest plot

1

57

Std. Mean Difference (IV, Random, 95% CI)

‐0.49 [‐1.02, 0.04]

2.1 Psychodynamic therapy plus TCA vs. TCA

1

57

Std. Mean Difference (IV, Random, 95% CI)

‐0.49 [‐1.02, 0.04]

3 Depressive symptoms Show forest plot

1

74

Std. Mean Difference (IV, Random, 95% CI)

‐0.11 [‐0.57, 0.35]
Figuras y tablas -
Comparison 10. Psychological combined with antidepressant medication versus antidepressant medication alone
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Comparison 11. Psychological combined with antidepressant medication versus no intervention or usual care (medium term)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Days of sickness absence Show forest plot

3

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 Enhanced primary care vs. CAU

2

969

Std. Mean Difference (IV, Random, 95% CI)

‐0.02 [‐0.15, 0.12]

1.2 Telephone outreach and care management program vs. CAU

1

604

Std. Mean Difference (IV, Random, 95% CI)

‐0.21 [‐0.37, ‐0.05]

2 Employment status Show forest plot

1

1356

Risk Ratio (M‐H, Random, 95% CI)

1.08 [0.99, 1.18]

2.1 Enhanced primary care vs. CAU

1

1356

Risk Ratio (M‐H, Random, 95% CI)

1.08 [0.99, 1.18]

3 Depressive symptoms Show forest plot

2

693

Std. Mean Difference (IV, Random, 95% CI)

‐0.22 [‐0.37, ‐0.07]

3.1 Enhanced primary care vs. CAU

1

89

Std. Mean Difference (IV, Random, 95% CI)

‐0.14 [‐0.56, 0.28]

3.2 Telephone outreach and care management program vs. CAU

1

604

Std. Mean Difference (IV, Random, 95% CI)

‐0.23 [‐0.39, ‐0.07]

4 Depressed yes/no Show forest plot

1

1356

Risk Ratio (M‐H, Random, 95% CI)

0.89 [0.81, 0.98]

4.1 Enhanced primary care vs. CAU

1

1356

Risk Ratio (M‐H, Random, 95% CI)

0.89 [0.81, 0.98]

5 Work functioning Show forest plot

1

604

Std. Mean Difference (IV, Random, 95% CI)

0.50 [0.34, 0.66]

5.1 Telephone outreach and care management program vs. CAU

1

604

Std. Mean Difference (IV, Random, 95% CI)

0.50 [0.34, 0.66]
Figuras y tablas -
Comparison 11. Psychological combined with antidepressant medication versus no intervention or usual care (medium term)
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Comparison 12. Exercise intervention versus no intervention or care as usual

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Days of sickness absence Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 Supervised strength training vs. relaxation

1

65

Std. Mean Difference (IV, Random, 95% CI)

‐1.11 [‐1.68, ‐0.54]

1.2 Aerobic exercise vs. relaxation/stretching

2

180

Std. Mean Difference (IV, Random, 95% CI)

‐0.06 [‐0.36, 0.24]

2 Depressive symptoms Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 Supervised strength training vs. relaxation

1

65

Std. Mean Difference (IV, Random, 95% CI)

0.15 [‐0.39, 0.68]

2.2 Aerobic exercise vs. relaxation/stretching

2

180

Std. Mean Difference (IV, Random, 95% CI)

0.18 [‐0.12, 0.48]
Figuras y tablas -
Comparison 12. Exercise intervention versus no intervention or care as usual
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