The design and feasibility of a work-focused relational group-CBT treatment programme to enhance job retention in employed service-users with moderate-severe recurrent depression.

Background:
Employees with moderate-severe recurrent depression are at risk of losing their jobs. A search of the literature revealed that most psychotherapeutic interventions are not work-focused, and there are none that have been specifically designed to enhance job retention in employed service-users of UK Community Mental Health Teams. A subsequent update of the research evidence using the same literature search strategy plus another search with more stringent inclusion criteria found several studies of work-focused psychotherapeutic interventions. However, but there is still a gap in terms of work-focused psychotherapeutic interventions specifically designed for employees with more severe mental health problems.
Methods:
The Medical Research Council guidance for the development and evaluation of complex interventions was used throughout this study. Firstly, an effectiveness review of relevant psychotherapeutic interventions revealed several over-arching principles which appeared to underpin their effects such as using a care pathway incorporating multi-disciplinary teamwork, guideline concordance, informed clinical decision-making, tracking of progress, and the use of outreach to encourage clients to complete treatment.
Secondly, a stakeholder consultation was undertaken during the planning period, and realist analysis of the focus group data identified six plausible mechanisms of change which allowed for modification of the new intervention design and refinement of the programme theory.
Thirdly, piloting involved a small feasibility study using a quasi-experimental pre-post design with eight participants which generated both quantitative and qualitative data regarding clinical and work outcomes.
Fourthly, a further stakeholder consultation was undertaken during the reviewing period to consider re-design of the new intervention in terms of improving acceptability and accessibility.
Finally, a process of mixed methods data integration was used to make recommendations for further implementation and evaluation in a definitive trial.
Results:
Six provisional Context-Intervention-Mechanism-Outcome (CIMO) configurations were developed into a programme theory. Overall, implementation and evaluation of the new intervention were feasible although problems were encountered in recruiting sufficient numbers for randomisation, and with collecting follow up data. It was also expensive to provide compared to CBT programmes in primary and secondary mental healthcare services. Outcomes suggest the new intervention is a promising treatment for moderate-severe recurrent depression for some women and may help them in maintaining their employment. Acceptability could be improved by making the new intervention more interesting and stimulating, with a focus on coping over the long-term. Accessibility could be improved by making the new intervention more understandable, delivering it at the worksite, and making it peer-led.
Conclusions:
Job retention for employed service-users may be enhanced if the tertiary individual level Treatment Programme is re-designed as a primary organisational level Training (and staff support) Programme informed by group-CBT.