当院のリワークプログラム参加者における復職に関連する因子の検討

Abstract

Since the 1990s, many psychiatric clinics and hospitals in Japan have started rehabilitation programs for patients who have had long-term absence from work because of mental disorders. At Nara Medical University Hospital, we started a program for returning to work from 2015. In this study we investigated factors associated with return to work among participants in Nara Medical University Hospital's rework program from July 1, 2015, to September 30, 2019, who were examined through a retrospective study. In our program, sessions were held twice a week over 12 weeks. Most participants had been diagnosed with depression or bipolar disorder, but patients with other diseases were also accepted. A total of 49 patients participated in the study, 25 of whom could return to work and 24 who could not within 6 months after the rogram. The average age was 37.33, with 38 (77.6%) men and 11 (22.4%) women. Of the participants, 63.3% had a diagnosis of depression, 16.3% bipolar disorder, and 6.1% adjustment disorder. The baseline survey found no differences in demographic characteristics, occupational characteristics, or clinical features between those able to return to work and those who were unable. Due to significant differences in scores on the HAM-D (Hamilton Rating Scale for Depression) and PRRS (Psychiatric Rework Readiness Scale) at the beginning of the program, gender, age, and HAM-D and PRRS scores were assumed to be confounding factors. Propensity score matching was used to analyze the data. However, there was no difference between the HAM-D scores of the two groups at the end of the program. On the PRRS, the scores for "grooming," "feeling a trauma against their workplace," and "interest in work" were higher in the group that could return to work. In the Standardized Assessment Sheet of the Rework Program, the two items of "conversation" and "objective comprehension of the disease" showed differences between the two groups. The possibility that improvement of these items will lead to early return to work has been suggested. Limitations of our study are that the sample size was small and we could not evaluate the effect of the program because there was no control group. Since we set as the outcome only success or failure in returning to work, we could not investigate repeated sick leave or relapse. Further long-term study in larger samples is necessary to verify the factors associated with another sick leave or relapse and we expect it will help patients to keep working.