The effectiveness of cognitive work hardening in preparing people with depression to return to work
Cognitive Work Hardening , Return-to-Work , Occupational Therapy , Depression
RATIONALE: Work absences due to depression are prevalent, suggesting the need for interventions addressing the challenges facing people returning to work following depression. Few such interventions have been developed and evaluated. Cognitive work hardening is a return-to-work intervention for people on mental health disability leaves. Anecdotal evidence supports its use for individuals returning to work following a depressive episode; however, it has not been systematically evaluated. OBJECTIVES: This research aimed to: 1) examine the theoretical underpinnings of cognitive work hardening; 2) test the effectiveness of cognitive work hardening in preparing people to return to work following a depressive episode; and 3) identify key elements of cognitive work hardening based on participants’ experiences. METHODS: Intervention mapping was used to analyze cognitive work hardening by deconstructing it into fundamental elements and theoretical underpinnings including occupational therapy models. Intervention effectiveness was assessed with a single group (n = 21) pre-post study design. Participants reported their return to work readiness using work ability, fatigue, and depression measures. Participants shared their experience at intervention completion and at 3-month follow-up. Work status and sense of well-being were also reported at follow-up. RESULTS: The Person-Environment-Occupation (PEO) Model, the Canadian Model of Occupational Performance and Engagement (CMOP-E), and the Canadian Model of Client-Centred Enablement (CMCE) emerged as occupational therapy models underlying cognitive work hardening. Self-reported work ability, fatigue, and depression severity significantly improved from pre to post intervention. At follow-up, most participants were off disability with 76% either working or engaged in other meaningful occupation. Main gains were reported in routine, work stamina, self-confidence, cognitive abilities, and coping strategies. Participants identified structure, work simulations, realism of simulated work environment, support, and education as key intervention elements. CONCLUSIONS: Cognitive work hardening shows promise as a return-to-work intervention following a depressive episode. Participation in cognitive work hardening improved participants’ self-reported work readiness with positive work status and well-being at 3-month follow-up. Findings inform the fields of return-to-work and occupational therapy by offering an occupationally-focused return-to-work intervention with the potential for wider adoption and improved health outcomes.