Cognitive Impairment, Depression in the Workplace

To date, the psychopharmacologic treatment of MDD has largely focused on mitigating depressed mood. However, in the context of workplace productivity, accumulating evidence suggests that impaired cognitive function is a key hindrance to work functioning, workplace adjustment, and patient-reported outcomes, 1, 7, 9 an observation supported by the fact that disturbances in cognition are included as part of a list of criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).1 Moreover, data evaluating aspects of cognition among mixed populations of patients experiencing a first or multiple episodes of MDD have demonstrated the magnitude of cognitive deficit to be of clinical relevance, with effect size estimates ranging from 0.2 to 0.7 among both symptomatic and asymptomatic individuals.1, 10 Up to this point, the only psychopharmacologic agents that have demonstrated independent and direct effects on cognitive function are vortioxetine and duloxetine.11-13

Studies evaluating the impact of alternate and/or concurrent interventions such as psychotherapy (eg, cognitive behavioral therapy), cognitive remediation, and employee assistance programs have suggested that barriers to employees returning to work include the failure to identify and accommodate their current capacity to work, subsequent frustration over perceived limitations, and communicating these experiences and potential solutions to coworkers and/or supervisors.1,14

Notably, a bidirectional relationship between these barriers and the risks associated with work stress and onset of MDD (eg, sources of perceived stress include psychological demand, lack of social support from coworkers/supervisors, and skill discretion) has been identified. 15 These observations suggest that rather than having occupational interventions to accelerate recovery and the return to work solely for individuals with MDD, it may be worthwhile to implement services endorsing mental and physical health to all employees with future return on investment through increased productivity and higher rates of sustained employment, thereby avoiding the hidden costs of depression (ie, presenteeism).7,14,15

Currently, no comprehensive, cost-effective, and scalable measure of cognitive function exists for this clinical population.1 This urgent need to further refine measurable mediators of functional outcomes in MDD has prompted the development of the THINC-it tool: a digitized screening application intended for the objective measurement of cognitive function using measurement tools commonly employed in interventional studies for this clinical population (NCT02508493).