The Lam Employment Absence and Productivity Scale (LEAPS)

• The Lam Employment Absence and Productivity Scale, or LEAPS, provides important information on how patients are functioning at work. This tool can help physicians make management decisions such as whether or not a patient should stay at work, whether work functioning improves along with symptoms, and whether changes in treatment are needed to optimize work functioning.

• The LEAPS was designed specifically for the clinical practice setting. It is a 10-item, self-rated scale that takes only 3 to 5 minutes for the patient to complete. It is simple and easy to use. Patients can complete the LEAPS in the waiting room or at home, and can score it themselves.

• The items were chosen based on the symptoms that have the most impact on work productivity and the most common productivity problems experienced by patients with depression. The LEAPS was recently validated in a sample of 234 consecutive working patients meeting DSM-IV criteria for MDD attending a mood disorders outpatient clinic (Lam et al, 2009).

• How can the LEAPS be used to guide clinical management of working patients with depression? Since the LEAPS is not a diagnostic tool, it should be used in conjunction with a symptom rating scale such as the PHQ-9 or the QIDS-SR. A key benefit of the LEAPS scale is that the total score can provide a quick measure of the degree of impairment in a patient’s occupational functioning.

• The individual productivity items can also help guide treatment decisions including whether it is appropriate and/or safe for the patient to remain at work; or whether the patient should take time off work. For example, a patient in a safety-sensitive job who endorses making more mistakes at work might benefit from workplace accommodation or a leave from work.

• The LEAPS can also help monitor changes in occupational functioning over time. By using a validated tool such as the LEAPS, clinicians can be assured they are monitoring functional outcomes in a standardized way. Furthermore, the LEAPS can serve as a useful charting tool to assess patient progress. The LEAPS total score provides a quick gauge of how the patient is functioning at work, which can save physicians time by eliminating the need to write notes describing how the patient is doing.

• Patients can fill in the LEAPS during follow-up visits (for example, at 4-week intervals or as clinically appropriate). Ideally, improvements in work functioning should parallel improvements in symptoms, however full functional recovery may take longer to achieve than symptomatic remission.

Download the LEAPS

• Please note, LEAPS is freely available for individual clinical use.
  For other uses, including research, please contact Dr. Lam, r.lam@ubc.ca

• LEAPS description and scale
• LEAPS, version Française
• LEAPS, Danish version   (thanks to Professor Per Bech)
• LEAPS, Mandarin version   (thanks to Chen Hu, MD)
• LEAPS, Spanish version   (thanks to Esther Alonzo-Prieto, PhD and Bernardo Ng, MD)
• LEAPS, Thai version   (thanks to Wanida Pumpaisalchai, PhD)
• LEAPS, Russian version   (thanks to Gvozdetskiy Anton Nikolaevich)

 

Video about using the LEAPS

• Dr. Lam discusses measurement-based care, using rating scales like the LEAPS.

And check out MoodFX, which includes the LEAPS

• MoodFX (pronounced “Mood Effects”) is a new, free, interactive mobile web app designed to help Canadian workers with clinical depression.
• MoodFX allows its users to easily and conveniently monitor their symptoms using validated clinical questionnaires, including:
  • Patient Health Questionnaire (PHQ-9) for symptoms of depression
  • Generalized Anxiety Disorder questionnaire (GAD-7) for symptoms of anxiety
  • LEAPS for work functioning
  • Perceived Deficits Questionnaire (PDQ-5) for troubles with cognition and thinking
  • Frequency, Intensity and Burden of Side Effects Rating (FIBSER) for medication side effects
• You can explore MoodFX, and sign for free, at www.MoodFx.ca.
• MoodFX helps patients to learn about and evaluate their symptoms and allows clinicians to easily implement measurement-based care with their patients. A randomized controlled trial (RCT) found that use of MoodFX was associated with improved outcomes in patients with depressive disorders.

References:

Click on link for pdf copy of papers (if link unavailable or not accessible, please contact workingwithdepression@ubc.ca for pdf)

• Lam RW, Michalak EE, Yatham LN. A new clinical rating scale for work absence and productivity: validation in patients with major depressive disorder. BMC Psychiatry 2009; 9:78.
  The original validation study for the LEAPS.

• Lam RW. Lam Employment Absence and Productivity Scale (LEAPS): Further validation studies in major depressive disorder (abstract). Value in Health 2014; 17:A195.
  Further validation data for the LEAPS, including test-retest reliability and responsivity to change (abstract of a poster presentation).

• Lam RW, Lamy FX, Danchenko N,et al. Psychometric validation of the Perceived Deficits Questionnaire-Depression(PDQ-D) instrument in US and UK respondents with major depressive disorder. Neuropsychiatr Dis Treat 2018; 14:2861-77.
  This study includes mean scores of the LEAPS in depressed and non-depressed samples.

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• Li VW, Sahota J, Dev DK, Gill DD, Evans VC, Axler A, Chakrabarty T, Do A, Keramatian K, Nunez JJ, Tam EM, Yatham LN, Michalak EE, Murphy JK, Lam RW. A randomized evaluation of MoodFX, a patient-centred e-health tool to support outcome measurement for depression. Can J Psychiatry. 2024 Jul;69(7):493-502.
  This study found that use of MoodFX, web-based tool to track symptoms and functioning (including the LEAPS) and to support self-management, was associated with improved outcomes in patients with depressive disorders.

• Li VW, Morton E, Michalak EE, Tam EM, Levitt AJ, Levitan RD, Cheung A, Morehouse R, Ramasubbu R, Yatham LN, Lam RW. Functional outcomes with bright light in monotherapy and combined with fluoxetine in patients with major depressive disorder: Results from the LIFE-D trial. J Affect Disord 2021; 297:396-400.
  Functional outcomes including the LEAPS from our randomized controlled trial of light therapy for nonseasonal depression.

• McInerney SJ, Chakrabarty T, Maciukiewicz M, Frey BN, MacQueen GM, Milev RV, Ravindran AV, Rotzinger S, Kennedy SH, Lam RW. Cognition and its association with psychosocial and occupational functioning during treatment with escitalopram in patients with major depressive disorder: A CAN-BIND study report. Can J Psychiatry. 2021; 66:798-806.
  Another CAN-BIND report about the important relationships between cognition and functioning (including the LEAPS).

• Moscovici M, et al. Psychosocial predictors of cognition in bariatric surgery. Psychosomatics. 2019; 60:164-171.
  A study using the LEAPS as an outcome measure. A notable finding was that perceived cognition (assessed by the PDQ-5 – see Rating Scales) was significantly associated with work impairment (assessed by the LEAPS) even when controlling for depression and anxiety severity. This finding adds to the evidence showing the importance of cognition for work productivity.
  

• Jin-Sung Park JS, et al. Psychological changes and employment outcomes after kyphosis correction in patients with ankylosing spondylitis. Spine 2019; 44:996-1002.
  A study using the LEAPS as an outcome measure.

• Kantarovich K,et al. Employment outcomes 2 years after bariatric surgery: Relationship to quality of life and psychosocial predictors. Obes Surg 2019; 29:2854-61.
  A study using the LEAPS as an outcome measure.

• Kennedy SH, Lam RW, Rotzinger S,et al. Symptomatic and functional outcomes and early prediction of response to escitalopram monotherapy and sequential adjunctive aripiprazole therapy in patients with major depressive disorder: A CAN-BIND-1 report. J Clin Psychiatry 2019; 80:18m12202.
  A study from our CAN-BIND group using the LEAPS as an outcome measure.

• Alonso-Prieto E, Rubino C, Lucey M, Evans VC, Tam EM, Woo C, Iverson GL, Chakrabarty T, Yatham LN, Lam RW. Relationship between work functioning and self-reported cognitive complaints in patients with major depressive disorder treated with desvenlafaxine. Psychiatry Res 2019; 272:144-8.
  This is a secondary analysis of the Lam et al 2016 study showing that cognitive complaints predict work functioning (including the LEAPS) independent of improvement in depressive severity.

• Silverberg ND, Panenka WJ, Iverson GL. Fear avoidance and clinical outcomes from mild traumatic brain injury. J Neurotrauma. 2018; 35:1864-73.
  A study using the LEAPS as an outcome measure.

• Terry DP, et al. Workplace and non-workplace mild traumatic brain injuries in an outpatient clinic sample: A case-control study. PLoS One 2018; 13:e0198128.
  A study using the LEAPS as an outcome measure.

• Silverberg ND, Panenka WJ, Iverson GL. Work productivity loss after mild traumatic brain injury, Arch Phys Med Rehabil 2018; 250-256.
  A study using the LEAPS as an outcome measure.

• Kaser M, et al. Modafinil improves episodic memory and working memory cognition in patients with remitted depression: A double-blind, randomized, placebo-controlled study. Biol Psychiatry Cogn Neurosci Neuroimaging 2017 Mar;2(2):115-122.
  A study using the LEAPS as an outcome measure.

• Sarfati D, Evans VC, Iverson GI, Woo C, Yatham LN, Lam RW. The impact of fatigue and energy on work impairment in patients with major depressive disorder treated with desvenlafaxine. Int Clin Psychopharmacology 2017: 32:343-349.
  This is a secondary analysis of the Lam et al 2016 study showing the importance of fatigue on work functioning using the LEAPS.

• Sarfati D, Stewart K, Woo C, Parikh SV, Yatham LN, Lam RW. The effect of remission status on work functioning in employed patients treated for major depressive disorder. Ann Clin Psychiatry. 2017; 29:11-16.
  This paper describes a secondary analysis of the Lam et al 2013 trial regarding the importance of symptom remission on functional outcomes, including the LEAPS.

• Lam RW, Iverson GI, Evans VC, Yatham LN, Stewart K, Tam EM, Axler A, Woo C. The effects of desvenlafaxine on neurocognitive and work functioning in employed outpatients with major depressive disorder. J Affect Disord 2016; 203:55-61.
  This study examines the relationship between neuropsychological performance and work functioning (including the LEAPS) before and after antidepressant treatment.

• Pumpaisalchai W. Validity and reliability of a Thai version of Lam Employment Absence and Productivity Scale (LEAPS-T) for paid work in major depressive disorder patients. Rajanukul Institute Journal 2016; 31:14-24.
  This is a pdf copy of the validation study for the Thai version of the LEAPS (abstract is in English, paper is in Thai).

• Lam RW, Parikh SV, Ramasubbu R, Michalak EE, Tam EM, Axler A, et al. Effects of combined pharmacotherapy and psychotherapy for improving work functioning in major depressive disorder. Br J Psychiatry 2013; 203:358-365.
  This is a clinical trial where the LEAPS showed responsivity to change as an outcome measure.

• Sockalingam S, et al. Employment outcomes one year after bariatric surgery: the role of patient and psychosocial factors. Obes Surg 2015; 25:514-522.
  A study using the LEAPS as an outcome measure.

• Despiegel N, et al. The use and performance of productivity scales to evaluate presenteeism in mood disorders. Value Health 2012; 15:1148-61.
  A systematic review of productivity scales, including the LEAPS.

• Abma FI, et al. Evaluation of the measurement properties of self-reported health-reported work-functioning instruments among workers with common mental disorders. Scand J Work Environ Health 2012; 38:5-18.
  Another systematic review of work functioning scales, including the LEAPS.

• Lam RW, Filteau MJ, Milev R. Clinical effectiveness: the importance of psychosocial functioning outcomes. J Affect Disord 2011; 132:S9-13.
  This  paper reviews the rationale of using functional outcome scales (like the LEAPS) for the clinical care of people with depression.