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Long-term sickness absence and depression detection 2009 – round 1

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This national clinical audit measures how well occupational health professionals are assessing and managing depression in NHS staff on long-term sickness absence. The aim of the audit is to raise the standard of occupational health care by evaluating performance against evidence-based best practice, working with occupational health practitioners to plan targeted quality improvement interventions and developing the tools to support these interventions. The audit questions reflect evidence-based guidance from the National Institute for Health and Clinical Excellence (NICE) on depression and the management of long-term sickness absence.

Key recommendations

  • There were very high levels of compliance with the NICE Guideline on the Management of Depression in some consultations (regardless of the severity of the case), and low levels of compliance in others. This finding shows that the NICE Guideline can and is being followed in some occupational health departments and that further work is needed to achieve a higher and consistent standard of care nationally. Documentation in the case notes should be comprehensive. •
  • 58% of all cases were screened for depression. However, screening occurred in a much higher proportion of cases referred for a psychological problem (83%) than those with a different diagnosis (15%). This finding shows that many more consultations need to include screening for depression, particularly where the presenting problem is a physical one.
  • In 18% of cases with evidence of distress, the OH professional asked about six core symptoms of depression. 11% of cases were asked about none of the six symptoms. These findings suggest that occupational health professionals need to include more questions about the core symptoms of depression in their consultations, to avoid missing depression in staff on long-term sickness absence.
  • 31% of cases with evidence of distress were asked about thoughts of suicide or deliberate self-harm. This figure was slightly higher (37%) for cases with a diagnosis of depression. Of those who reported thoughts of this nature, two thirds were asked further important questions about their plans and half were asked about any previous acts. The management of employees with distress and depression could be improved if appropriate questions about suicide were more frequently asked by occupational health professionals.
  • Over 60% of cases with distress were asked about family members. 33% were asked about alcohol and 9% were asked about drugs. A better understanding of potential barriers to recovery would be gained by asking about aspects of home and family life more often. Importantly, more consultations should include questions about alcohol and illicit drug use. Variations between occupational groups
  • A higher proportion of nurses and a lower proportion of doctors were entered into this audit than would be expected from the demographics of the NHS workforce. It is important that trusts ensure that all staff groups have full access to occupational health services and are encouraged to seek advice.
  • Few other differences between occupational groups were seen in the results for the other audit questions, which is reassuring.